手术、伽玛刀治疗三叉神经痛的疗效及预后

Efficacy and prognosis of trigeminal neuralgia treated with surgical excision or gamma knife surgery

目的:比较三叉神经痛(trigeminal neuralgia,TN)经微血管减压术(microvascular decompression,MVD)治疗与伽玛刀(gamma knife surgery,GKS)治疗后的疗效、并发症、复发情况等特点,探讨TN患者MVD与GKS的治疗与预后。方法:采用电话、信件、门诊及伽玛刀中心复查的方式对1996年12月至2010年6月期间接受MVD治疗的61例及GKS治疗的86例TN患者进行随访,应用χ2检验对随访到的患者术后1,6,12个月及末次随访时的疼痛缓解情况进行分析。结果:共有102例患者获得随访,随访时间3到151个月不等。42例获得随访的MVD治疗患者,1,6,12个月及末次随访时疼痛累积缓解率分别为90.48%,95.24%,92.86%和95.24%;60例获得随访的GKS治疗患者,1,6,12个月及末次随访时疼痛累积缓解率分别为23.33%,83.33%,86.67%和90%。两种治疗方法的疗效差异无统计学意义(χ2=2.053,P=0.152),近期疼痛缓解率(1个月内)差异有统计学意义(P<0.01),远期疼痛缓解率差异无统计学意义(P>0.05)。结论:MVD近期疼痛缓解率高于GKS,两者远期疼痛缓解率无明显差异,均可用于TN患者的治疗。

Objective： To evaluate the curative effects and complications when using microvascular decompression （MVD） or gamma knife surgery （GKS） to treat trigeminal neuralgia （TN）. And toinvestigate the prognosis for TN after these treatments. Methods： Sixty-one TN patients treated using MVD and eighty-six YN patients treatea using GKS were enrolled by means of telephone, letter or out-patient recheck; the patients had originally presented from December 1996 to June 2010. A chi-square test was applied to follow-up data on pain relief after i monthj 6 months and 12 months, and at the final follow-up. Results： One hundred and two patients were followed for 3-151 months. Cumulative pain relief rates at 1, 6, 12 months and at end times were 90.48%, 95.24%, 92.86%, and 95.24%, respectively, for forty-two MVD-treated patients, and 23.33%, 83.33%, 86.67% and 90% for sixty GKS-treated patients, respectively. The effects of two methods for treatment of TN was not statistically different （χ2 = 2.053, P=0.152）. Pain relief rates in the short-term （first month） demonstrated statisticallysignificant differences （P〈0.O1）, but pain relief rates in the long-term showed no significant differences （P〉0.05）. Conclusion： Immediate pain relief with MVD treatment is higher than with GKS, but in the long term both treatments were comparable.