微血管减压术治疗原发性面肌痉挛后延迟治愈现象及意义探讨

Delayed resolution after microvascular decompression for treatment of hemifacial spasm

目的探讨原发性面肌痉挛患者行微血管减压术后延迟治愈现象与患者病程的关系。以期为面肌痉挛患者术后疗效的判断及手术无效者再次手术的时间选择提供参考。方法回顾性收集北京军区总医院附属八一脑科医院及北京市密云医院神经外科自2006年5月至2012年7月行微血管减压术治疗的136例原发性面肌痉挛患者的临床资料，共随访2年，并利用统计学方法分析其中延迟治愈患者的病程长短与延迟治愈时间的关系。结果136例患者中延迟治愈者共35例（2型23例，3型12例），病程最长为32年，最短为0．8年，平均8．87年；最短延迟治愈时间为2d，最长为380d，平均93．94d。统计发现，患者病程长短与延迟治愈时间之间呈简单线性回归关系，差异具有统计学意义（非标准化系数为12．042±0．681，t=17．683，P=0．000），且得出回归曲线方程为Y=12．042X-13．159。结论神经外科医师在评估原发性面肌痉挛患者微血管减压术后效果及进行再次手术时要考虑到延迟治愈现象，对病程较长的患者应适当延长疗效评估的时间。

Objective To explore the relationship between delayed resolution of patients with hemifacial spasm after microvascular decompression and course of disease to provide reference for curative effect judgment and selection of re-operation time for those initial operation was failed. Methods Retrospective analysis of a consecutive series of 136 specimens, collected in our hospitals from May 2006 to July 2012, was performed. After the follow-up of 2 years, the relationship between the course of disease and delayed resolution time was analyzed with statistical method. Results In all the 136 patients accepted microvascular decompression, 35 were diagnosed as having delayed resolution （type Ⅱ： 23 and type Ⅲ： 12）, including 10 males and 25 females; the average course of disease was 8.87 years （ranged from 0.8 to 32 years）; the average delayed resolution was 93.94 days （ranged from 2 to 380 days）. Regression analysis showed that the course time of disease was positively correlated to delayed resolution time （non-standardized coefficien=12.042±0.681, t=17.683, P=0.000） with a regression curve equation as Y=12.042X-13.159. Conclusion Neurosurgeons should understand the phenomenon of delayed resolution after microvascular decompression in patients, and be aware of it when assessing the effect of operation or implement a second operation. For patients with longer course of disease, we should extend appropriately the assessing time.