颈侧入路舌咽神经切断术治疗原发性舌咽神经痛

Glossopharyngeai neurotomy through lateral cervical approach to treat idiopathic glossopharyn- geal neuralgia

目的探讨颈侧入路舌咽神经切断术的两种方式（颈侧切舌咽神经、喉上神经切除术与单纯性舌咽神经切除术）治疗原发性舌咽神经痛的疗效及差异。方法回顾性对比分析12例颈侧入路舌咽神经、喉上切断术（以下简称“术式一”）和13例颈侧切入路单纯舌咽神经切断术（以下简称“术式二”）治疗原发性舌咽神经痛患者的临床资料、手术方法、手术效果以及随访结果。结果“术式一”术后随访3个月～3年，随访中位时间为15个月。12例行颈侧入路舌咽神经切断术的原发性舌咽神经痛患者中，11例患者疼痛完全缓解，1例症状明显减轻，疼痛缓解率达100％，疼痛完全缓解率达91．7％。“术式二”术后随访4个月-4．5年，随访中位数为15个月。13例患者中有11例疼痛症状完全消失，1例术后3个月疼痛症状再次发作，术后4个月经喉上神经封闭治疗后疼痛症状完全消失；1例术后症状再次出现，后行“开颅血管神经减压术”，术后未再复发。疼痛缓解率达92．3％，疼痛完全缓解率达84．6％。结论颈侧切舌咽神经、喉上神经切除术与单纯性舌咽神经切除术两种手术方法均是治疗原发性舌咽神经痛的有效方法，且两者在治疗效果上不存在明显差异，术后并发症均轻微。在治疗原发性舌咽神经痛时，建议首选颈侧切单纯舌咽神经切断术，封闭或切断喉上神经可作为颈侧切入路单纯舌咽神经切断术效果不理想的补充。

Objective To investigate the effect and differences of lateral cervical approach glos- sopharyngeal nerve transection in two ways （ lateral cervical glossopharyngeal neurotomy, superior larynge- al nerve resection with simple glossopharyngeal nerve resection） to treat idiopathic glossopharyngeal neu- ralgia. Methods The clinical data, surgical methods, surgical effect and follow-up results of 12 patients treated by glossopharyngeal nerve, laryngeal neurectomy through lateral cervical approach （hereinafter re- ferred to as ＇surgical one＇）, and 13 patients treated by simple glossopharyngeal nerve transection through lateral cervical approach （ hereinafter referred to as ＇ surgical two＇ ） were respectively analyzed. Results ＇ Surgical one＇ ： Patients were followed-up for 3 months to 3 years, and the median followed-up time was 15 months. Of the 12 patients, 11 patients with complete pain relief, 1 patient with ameliorated symptoms, the pain relief rate was 100% , and the pain completely relief rate was 91.7%. ＇ Surgical two＇ ：Patients were followed-up for 4 months to 4. 5 years, and the median followed-up time was 15 months. Of the 13 patients, the pain disappeared completely in 11 cases, the pain recurrence at 3 months post-operatively in 1 case, and the pain disappeared completely after superior laryngeal nerve block at 4 months post-operatively. The symptoms recurred postoperatively in 1 case, no recurrence after neurovas- eular decompression craniotomy. Pain relief rate was 92.3% and the pain completely relief rate was 84.6%. Conclusions Glossopharyngeal nerve, laryngeal neurectomy through lateral cervical ap- proach and the simple glossopharyngeal neurotomy is the effective methods to treat idiopathic glosso- pharyngeal neuralgia, the effects have no significantly difference between the two groups, and the postoperative complications are minimal. In the treatment of primary glossopharyngeal neuralgia, glossopharyngeal neurotomy through lateral cervical approach is the preferred method, block or cut off the laryngeal nerve can be used as the complement of unsatisfied surgical result.