影响微血管减压术治疗原发性三叉神经痛效果的因素分析

Analysis of factors related to curative effect of microvascular decompression on primary trigeminal neuralgia

目的探讨微血管减压术(MVD)治疗原发性三叉神经痛(TN)的临床效果并分析其影响因素。方法回顾性分析2003年1月至2011年6月MVD治疗436例TN患者的临床资料。结果TN患者MVD后,病情立即缓解371例(85.1%),术后延迟缓解49例(11.2%),明显减轻12例(2.8%),疼痛改善不明显4例(0.9%)。出现并发症77例(17.7%)、不良反应105例(24.1%)。多因素Logistic回归分析结果显示疼痛分布区域、责任血管数量和MRA检查与否是影响MVD临床疗效的最主要因素。结论术前充分的影像学检查、缜密的手术计划、娴熟的显微操作技巧、明确责任压迫血管是提高MVD临床疗效的关键。

Objective To explore the curative effect of the microvascular decompression on the primary trigeminal neuralgia （PTN） and factors related to it. Method The clinical data of 436 patients with PTN treated by microvascular decompression from January, 2003 to June, 2011 were analyzed retrospectively. Results Of 436 patients with PTN, 371 （85.1%） received relief of PTN immediately, 49 （11.2%） relief of PTN delayedly, 12 （2.8%） significant decrease in PTN, and 4 （0.9%） insignificant decrease or uncharged in PTN after the decompression. The complications including fever, herpes, face palsy, cerebrospinal fluid leakage, decrease in hearing, intracranial infection and so on occurred in 77 patients （17.7%）, and the adverse reactions including headache, dizziness, nausea, vomit and so 9n occurred in 105 （24.1%） after the decompression. The multiple variants logistic regression analysis showed that the most important factors related to the curative effect of microvascular decompression on PTN included the numbers of the nerves branch involved by the neuralgia and the responsible vessels for PTN and MRA scan or not. Conclusion The important factors related to the curative effect of microvascular decompression on PTN include the preoperative sufficient imaging examination, careful oPerative plan, master microsurgical skill and the numbers of the involved nerves branches and responsible vessels for PTN.