原发性三叉神经痛显微血管减压术后复发相关因素的研究

Related factors of recurrence of primary trigeminal neuralgia after microvascular decompression

目的 探讨原发性三叉神经痛显微血管减压术后复发的相关因素。方法 回顾性分析我院147例首次经微血管减压术治疗的原发性三叉神经痛患者的临床资料,包括术前治疗方式、临床特征、术中所见、术后第1周时的疗效,并分析随访期内复发的相关因素。结果 147例患者平均随访39.5个月,17例（11.6％）复发;复发的单因素分析显示病程（x2=8.226,P=0.016）,临床特征（x2=4.940,P=0.026）,责任血管（x2 =45.759,P=0.000）,压迫程度（x2=13.811,P=0.003）,减压程度（x2=39.910,P=0.000）,外层蛛网膜（x2=33.117,P=0.000）,蛛网膜卡压（x2=27.245,P=0.000）,蛛网膜粘连（x2=20.710,P=0.000）是术后复发的危险因素;Logistic多因素回归分析显示：复发与外层蛛网膜（P =0.033）,蛛网膜系带卡压（P=0.008）,责任血管类型（P=0.002）,减压程度（P=0.004）相关。结论 显微血管减压术是治疗原发性三叉神经痛主要方式,蛛网膜因素可能在三叉神经痛发病机制和显微血管减压术中具有重要意义。

Objective To evaluate the related factors of the recurrence of primary trigeminal neuralgia after microvascular decompression（MVD）.Methods 147 patients with initial primary trigeminal neuralgia treated with MVD in our departerment were retrospectively analyzed.The preoperative treatment,clinical presentation,operative findings and postoperative outcomes were recorded.The related factors of recurrence were statically analyzed.Results The mean follow-up time was 39.5 months and the recurrence rate was 11.6% （17/147）.The univariate analysis showed that the duration of disease（x2 =8.226,P =0.016）,clinical presentation （x2 =4.940,P =0.026）,offending artery （x2 =45.759,P =0.000）,compression degree（x2 =13.811,P =0.003）,decompression degree （x2 =39.910,P =0.000）,outer arachnoid（x2 =33.117,P =0.000）,arachnoidcompression （x2 =27.245,P =0.000） and arachnoid adhesion（x2 =20.710,P =0.000）were statically related to the recurrence of neuralgia.After the Logistic regression analysis,the outer arachnoid （P =0.033）,arachnoid trabecula compression （P =0.008）,offending artery （P =0.002） and decompression degree （P =0.004） were the predictors of the recurrence.Conclusions MVD was effective in the treatment of primary trigeminal neuralgia.The arachnoid factors might play an important role in the pathogenesis of trigeminal neuralgia and MVD.