射频热凝术联合脉冲射频术治疗三叉神经眼支疼痛的疗效与安全性

Efficacy and safety of radiofrequency thermocoagulation with pulsed radiofrequency for V1 trigeminal neuralgia patients

目的就射频热凝术(RF)联合脉冲射频术(PRF)治疗三叉神经眼支疼痛的安全性与疗效进行分析。方法选取2012年1-12月在杭州市第一人民医院疼痛科住院的患者,根据入组标准建立前瞻性队列研究队伍。入组患者自由选择手术方式,分为RF组与RF联合PRF组,每组35例。通过手术即刻疗效和并发症、术后中远期疗效进行总体评价。结果 RF组患者术后即刻疼痛治愈率为88.57%(BNIⅠ级、Ⅱ级),RF联合PRF组患者术后即刻疼痛治愈率为91.43%(BNIⅠ级、Ⅱ级)。两组患者的无痛生存情况通过Kaplan-Meier法进行生存分析,并运用log-rank检验比较,两组差异有统计学意义(χ~2=5.178,P=0.023)。RF组术后14例患者发生了角膜反射减弱,角膜反射减弱恢复时间为(12.1±7.5)个月。RF联合PRF组术后6例患者发生了角膜反射减弱,角膜反射减弱恢复时间为(8.9±2.3)个月。两组患者角膜反射减弱发生率及角膜反射减弱恢复时间差异有统计学意义(χ~2=4.48,P=0.034;t=2.25,P=0.028)。结论 RF联合PRF治疗三叉神经眼支疼痛可以增加治愈率减少并发症,可推荐作为保守治疗无效不能耐受开颅手术三叉神经眼支疼痛患者的首先治疗方式。

Objective To evaluate the efficacy and safety of radiofrequeney thermocoagulation with pulsed radiofrequeney for V1 trigeminal neuralgia patients. Methods The prospective cohort study enrolled 70 patients with V1 primary trigeminal neuralgia, who were admitted to Pain Department, Hangzhou First People＇s Hospital from January to December 2012. The patients were divided into RF group （n = 35） and RF plus PRF group （n = 35 ） and followed up for 3 years for pain relief rate and complications. Results Postoperative cure rate of immedi- ate pain in RF group was 88.57% （BNI class I, II） and that in RF plus PRF group 91.43% （BNI class I, I1）. The pain relief rate was higher in RF plus PRF group, and the difference was statistically significant （X^2 = 5.178, P = 0.023）. Fourteen patients in RF group suffered corneal hypoesthesia and their recovery time was （12.1± 7.5） months and 6 in RF plus PRF group experienced corneal hypoesthesia and their recovery time was （8.9±2.3） months. The differences of incidence rate and recovery time were significant （X^2 = 4.48, P = 0.034; t = 2.25, P = 0.028）. Conclusions RF plus PRF is conducive to decreasing the recurrence of V 1 trigeminal neuralgia, reduc- ing the numbers of corneal hypoesthesia and shortening the recovery time. which is worth of clinical promotion.