面肌痉挛显微血管减压术后远期疗效及影响因素分析

Analysis of long-term outcome and its influential factors of microvascular decompression for hemifacial spasm

目的评价显微血管减压术(MVD)治疗面肌痉挛的远期疗效,并分析影响其疗效的相关因素。方法回顾性分析473例经MVD治疗的面肌痉挛病人的临床资料,观察术后疗效、复发率及相关并发症;并通过有序多分类Logistic回归分析影响MVD疗效的相关因素。结果经MVD治疗后痊愈359例(75.9%),缓解86例(18.2%),无效28例(5.9%),总有效率达94.1%。有序多分类Logistic回归分析显示:术中面神经受压程度和术中异常肌反应(AMR)检测消失情况对病人的远期疗效有显著影响(P<0.01)。随访期间复发11例,行再次手术5例。面瘫、耳鸣和脑脊液漏等术后并发症均在随访期间恢复,部分听力下降病人无改善。结论 MVD治疗面肌痉挛安全、有效。在明确解除责任血管压迫的前提下,术中面神经可见有压迹和术中AMR消失的病人,MVD的远期疗效更好。

Objective To evaluate the long-term outcome of microvascular decompression （MVD） for hemifacial spasm, and analyze the influential factors related to the therapeutic efficacy. Methods Clinical data of 473 patients with hemifacial spasm undergoing MVD were analyzed retrospectively, including therapeutic efficacy, recurrence rate and complications. Ordinal logistic regression analysis was used to analysis the relative factors influencing the efficacy of MVD. Results The patients were cured in 359 （75.9%）, relieved of their symptoms in 86 （18.2%）, suffered ineffective treatment in 28 （5.9%）, and the total efficiency was 94.1%. Ordinal logistic regression analysis showed that the severity of facial nerve compression and disappearance of abnormal muscle response （AMR） during MVD had a significant affect on the long-term outcomes （P 〈 0.01）. Eleven patients recurred and 5 patients received reoperation during the follow-up period. The postoperative complications such as facial paralysis, tinnitus and cerebrospinal fluid leakage got recovered, while a part of patients with hearing loss had no improvement during the follow-up period. Conclusions MVD is safe and effective for hemifacial spasm. Based on the premise of removing the compression of the responsible vessel, the long-term outcome of MVD is better in patients with pressure trace on the facial nerve and AMR disappearance during MVD.