显微血管减压术治疗原发性三叉神经痛疗效的相关因素

Influencing factors on the curative effect of microvascular decompression in the treatment of primary trigeminal neuralgia

目的探讨影响显微血管减压术(MVD)治疗原发性三叉神经痛(TN)疗效的相关因素。方法对153例原发性TN患者施行MVD,对临床资料行单因素χ2检验及Logistic多因素回归分析,评价影响MVD治疗原发性TN疗效的独立危险因素。结果 1疼痛完全消失125例,疼痛明显缓解26例,未愈2例;2103例单纯受动脉压迫,49例合并静脉压迫,1例无明显责任血管,合并静脉压迫的患者术后疼痛完全消除率(71%)较单纯动脉压迫者(81%)低,且差异有统计学意义(P<0.05);3 V2支疼痛的患者术后疼痛完全消除率(55%)较其他疼痛分布区患者低,差异有统计学意义(P<0.05),且V2支疼痛的患者,责任血管多自三叉神经的腹侧压迫(50%),且差异有统计学意义(P<0.05);4Logistic回归分析显示,静脉压迫和V2支疼痛是影响MVD治疗原发性TN临床疗效的独立危险因素。结论静脉压迫、V2支疼痛的患者术后疗效较差,为独立危险因素;V2支疼痛的患者,其责任血管多自三叉神经腹侧压迫三叉神经,这成为难治性V2支疼痛新的研究方向。

Objective To explore the influencing factors on the curative effect of microvascular decompression（ MVD）in the treatment of primary trigeminal neuralgia（ TN）. Methods MVD was performed in 153 primary TN patients.The independent risk factors on the curative effect were evaluated by single factor analysis of chi-square test and Logistic regression analysis. Results ① Pain vanished in 125 cases,obviously relieved in 26 cases,and remained unchanged in 2 cases. ② The artery was compressed in 103 cases,complicated with venous conflict in 49 cases,and 1 case had no obvious conflict. The pain-free rate of venous conflict（ 71%） was significantly lower than that of artery compression alone（ 81%,P〈0. 05）. ③ The pain-free rate of V2 was significantly lower than others（ P〈0. 05）. Half of the patients with V2 had their NVC at the ventral site of the nerve（ P〈0. 05）.④ Logistic regression analysis showed the vein and V2 were independent risk factors on the curative effect. Conclusion Patients with venous compression or V2 pain have poor curative effect. Venous compression and V2 pain are the independent risk factors. The ventral site is the crucial conflict site of V2,which can serve as a newtarget for the study of refractory trigeminal neuralgia.