伽玛刀治疗三叉神经痛时效关系多因素分析

Multivariate Analysis of Time-effect Relationship of Treatment of Trigeminal Neuralgia by Gamma Knife

目的评价三叉神经痛伽玛刀治疗长期随访中,治疗靶区解剖结构等多个因素对起效时间的影响。方法回顾性分析了57例完全随访的患者,通过Log-rank生存分析法分析了各个因素对起效时间的影响。结果 57例患者中有53例患者治疗有效,平均起效时间为6.15个月。经Log-Rank法发现,不同的靶区三叉神经暴露的长度差异有统计学意义(≤0.8cm vs.>0.8cm,P=0.0443);同时,≤0.8cm组中位起效时间及平均起效时间慢于>0.8cm组。不同的三叉神经根桥池段间隙宽度差异有统计学意义(≤1.1cm vs.>1.1cm,P=0.0206),≤1.1cm组中位起效时间和平均起效时间慢于>1.1cm组。患者不同性别的起效时间不同,差异有统计学意义(P=0.0142),男性患者中位起效时间及平均起效时间慢于女性患者,差异有统计学意义(P<0.05)。结论起效时间与靶区三叉神经暴露的长度及三叉神经根桥池段间隙宽度及男女性别有关。

Objective To evaluate the effect of multiple factors, such as the anatomical structure of the treatment target region, on the onset time in a long follow-up of trigeminal neuralgia treatment by gamma knife. Methods We retrospectively ana- lyzed 57 patients with complete follow-up, and analyzed the effect of various factors on the onset time by Log-rank survival analysis. Results The treatment was effective in 53 patients,with an average onset time of 6. 15 months. The difference of exposure length of the trigeminal nerve was statistically significant（ ≤0. 8cm vs. 〉 0. 8cm, P = 0. 0443 ）by Log-rank survival analysis; meanwhile the median onset time and mean time of ≤0. 8cm group was slower than those of 〉 0. 8cm group. The difference of gap width of pontine cistern segment of trigeminal nerve root was statistically significant （ ≤ 1.1era vs. 〉 1.1 em, P = 0. 0206 ） and the median onset time and mean tiine of ≤ 1.1 cm group was slower than those of 〉 1.1 cm group. The median onset time and mean onset time of male patients were slower than those of female patients, statistically significant（ P = 0. 0142）. Conclusion The onset time was related to the exposure length of trigeminal nerve in the target region, the gap width of pontine cistern segment of trigeminal nerve root and the sex.