双靶点半月节射频热凝术治疗原发性三叉神经痛的疗效分析

Double targets percutaneous radiofrequency thermocoagulation in treatment of primary trigeminal neuralgia

目的探讨双靶点经皮穿刺半月节射频热凝术（PRT）治疗原发性三叉神经痛（PTN）的疗效和安全性。方法选择广东省第二人民医院神经外科自2012年1月至2014年9月收治的行CT引导立体定向导航PRT治疗的PTN患者共60例，按随机数字表法将患者分为双靶点治疗组30例和单靶点治疗组30例，单靶点治疗组患者只进行1个靶点毁损，双靶点治疗组患者进行深、浅间隔3mm的2个靶点毁损。分别于术后1周、3个月、1年、2年比较2组患者的疗效和并发症。结果术后1年、2年，双靶点治疗组患者疗效优者所占比例（86．7％、70％1高于单靶点治疗组（60％、43％1，差异有统计学意义（P〈0．05）；术后3个月、1年、2年，双靶点治疗组患者疼痛复发率（O％、3.3％、6．7％）均低于单靶点治疗组（3.3％、10％、16．7％），但比较差异无统计学意义（P〉0．05）。2组患者术后均出现不同程度的患侧面部感觉减退，未出现角膜溃疡、复视、咀嚼无力、张口困难等并发症。术后1周、3个月、1年及2年，2组患者的面部麻木程度比较差异无统计学意义（P〉0．05）。结论采用双靶点PRT治疗PTN，与单靶点比较可明显提高术后疼痛缓解效果，并且不显著增加术后面部麻木程度。

Objective To discuss the curative effect of double targets percutaneous radiofrequency thermocoagulation （PRT） on primary trigeminal neuralgia （PTN） and its safety. Methods Sixty patients with PTN were randomly divided into single target treatment group and double targets treatment group. CT guided stereotactic location was used to navigate PRT; patients in the single target treatment group only accepted one target damage and those in the double targets treatment group accepted target damage with 3 mm of deep and shallow interval. The curative effects and complications were compared one week, 3 months, one and 2 years after the surgery. Results The percentage of patients with good curative effect in double targets treatment group was significantly higher than that in single target treatment group one and 2 years after surgery, with statistically significant difference （86.7% vs. 60%, 70% vs. 45%, P〈0.05）. Recurrence rates of double targets treatment group 3 months, one and 2 years after surgery were 0%, 3.3% and 6.7%, which were lower than those in single target treatment group （3.3%, 10% and 16.7%）, without significant difference （P〉0.05）. Ipsilateralfacial hypaesthesia of different degrees appeared in both groups, but complications as keratohelcosis, diplopia, chewing weakness or difficulty in opening mouth did not appear. And the degree of facial numbness in double targets treatment group was a little higher than that in single target treatment group without statistical significance （P〉0.05）. Conclusion Double targets PRT used in PTN treatment can obviously improve the postoperative pain relief and do not apparently increase the degree of postoperative facial numbness as compared with single target PRT.