枕下乙状窦后入路选择性舌咽神经迷走神经切断术治疗舌咽神经痛

Treatment of glossop haryngeal neuralgia with the methold of selective glossopharyngeal and vagus nerve rhizotomy by suboccipital retrosigmoid approach

目的 探讨枕下乙状窦后入路选择性舌咽神经、迷走神经部分根丝切断术治疗舌咽神经痛的有效性及安全性。方法 选择自2010年4月至2015年6月收治于陆军总医院附属八一脑科医院的原发性舌咽神经痛患者34例,其中12例行微血管减压（MVD）＋舌咽神经根切断术（PR）,22例行PR＋迷走神经根1-2组根丝切断术（VR）,观察远期治愈率、近期并发症及远期并发症。两组患者远期疗效、近期总并发症及远期总并发症的发生采用百分率（%）表示,率之间的比较使用卡方检验。结果 MVD＋PR组术后10例立即无疼痛,2例仍有疼痛,2例术后有复发,远期治愈率66.7%;PR＋VR组术后21例立即无疼痛,1例仍有疼痛,无复发,远期治愈率95.5%;PR＋VR组患者远期治愈率高于MVD＋PR组患者,且差异有统计学意义（χ^2=5.130,P〈0.05）。MVD＋PR组共3例有近期并发症,近期总并发症发生率25.0%,PR＋VR组共10例有近期并发症,近期总并发症发生率45.5%,两组间近期总并发症发生率差异无统计学意义（χ^2=1.376,P〉0.05）;MVD＋PR组共2例遗留远期并发症,远期总并发症发生率16.7%,PR＋VR组共5例遗留远期并发症,远期总并发症发生率22.7%,两组间远期总并发症发生率差异无统计学意义（χ^2=0.174,P〉0.05）。结论 选择性PR＋VR是安全的,其疗效优于MVD＋PR,应积极选择PR＋VR治疗GPN。

Objective To investigate the effectiveness and safety of surgical treatment of glossopharyngeal neuralgia with the methold of selective glossopharyngeal nerve root and vagus nerve root silk rhizotomy by suboccipital retrosigmoid approach. Methods Of 34 patients with glossopharyngeal neuralgia admitted to the Army General Hospital Affiliated Brain Hospital of Bayi primary from April 2010 to June 2015, 12 cases were treated with microvascular decompression （MVD）＋glossopharyngeal nerve root rhizotomy （PR）, 22 cases were treated with PR＋vagus nerve root 1-2 group rhizotomy （VR）, and then observe the long-term cure rate, short-term complications and long-term complications. The datas were analyzed with SPSS 19.0 statistical analysis software, long-term curative effect, recent total complications and long-term total complications in two groups of patients were expressed by percentage （%）, χ^2 test was used to the comparison of the rate of two groups. If P〈0.05, the difference was statistically significant. Results 10 cases after operation in group MVD＋PR were immediately and without pain, there were still 2 cases of pain and 2 cases of postoperative recurrence, long-term cure rate was 66.7%; 21 cases after operation in group PR＋VR were immediately and without pain, 1 case was still pain and no recurrence, long-term cure rate was 95.5%. Long-term cure rate between the two groups had significant difference （χ^2=5.130, P〈0.05）. MVD＋PR group：There were a total of 3 cases with recent complications, recent total complication rates were 25.0%, PR＋VR group：There were a total of 10 cases with recent complications, recent total complication rates were 45.5%, recent total complication rates between the two groups have no significant difference （χ^2=1.376, P＆gt;0.05）; MVD＋PR group left 2 cases of long-term complications, legacy total complication rates were 16.7%, PR＋VR group left 5 cases of long-term complications, legacy total complication rates were 22.7%, the legacy total incidence of complications between the two groups have no significant difference （χ^2=0.174, P＆gt;0.05）. Conclusion selective PR＋VR was safe, and its curative effect was better than the MVD＋PR, PR＋VR therapy should be actively choosed in patients with GPN.