三种径路射频热凝术治疗原发性三叉神经痛疗效分析

Clinical Significance of Trigeminal Neuralgia Treated Using Radiofrequency Thermocoagulation (RFT) with Different Approaches

目的 :评价 3种径路射频温控热凝术治疗原发性三叉神经痛的近、远期疗效。方法 :对 3 2 0例原发性三叉神经痛患者采用前侧路、侧路和颧下喙突前路 3种术式进行射频温控热凝术治疗 ,随访 1～ 6年 ,统计其疗效和复发率的关系。结果 :3 2 0例三叉神经痛患者射频温控热凝术的首次止痛有效率前侧路为 95 3 % ,侧路及颧下喙突前路为73 3 % ,两相比较差异显著 (P <0 0 1)。远期效果中 ,3种术式的优良率以前侧路为最高 98 3 % ,L路 95 7% ,Z路92 5 %。第 1次射频热凝术后有 2 9 1%病例复发 ,其中大多数经 2、3、4次再治疗又获得完全止痛。手术径路与复发有明显关系 ,前侧路的复发率远低于其它两种径路 (P <0 0 1)。全组发生 1例严重并发症 (眶尖综合征 )。结论 :前侧路法的首次止痛有效率高 ,止痛时间长 ,复发率低。颧下喙突前路法可作为三叉神经Ⅱ支痛的一种替代和补充。

Objective:The authors presented the short term and long term effects of the trigeminal neuralgia treated by RFT with anterior_lateral facial, lateral facial and trans_subzygomatic approaches. Methods:320 primary patients with trigeminal neuralgia were selected for this study. All these patients were followed up with the period of 1 to 6 years. Results:The first_time effective ratios of pain_relieve treated by using the anterior_lateral facial approach, and the lateral facial and the trans_subzygomatic, were 93 3% and 73 3% respectively. Most of the patients (92 5%) achieved excellent or good pain_relieve after treated by one of these three approaches. Compared with the lateral facial and trans_subzygomatic procedures, the anterior_lateral facial approach caused less recurrent rate in long term effects (P<0 01). The late recurrence was found in 93 patients, but pain_relieve effect still could be obtained by retreating with the former method and without difficulty or hazard. One patient had serious Rollets syndrome. Conclusion:It is concluded that the anterior_lateral approach is a method with more effective pain_relieve and less pain recurrence rate, and the trans_subzygomatic method can be used as a substitutive approach in the treatment of the second branch of trigminal neuralgia.