面肌痉挛术后无效与复发再手术分析

Analysis of reoperation for ineffectiveness and recurrence after surgery for hemifacial spasm

目的评价面肌痉挛术后无效或复发病例再次手术疗效和并发症发生情况。方法将手术治疗后无效或复发的32例面肌痉挛病人作为治疗组,同期首次手术治疗的100例面肌痉挛病人作为对照组,比较两组责任血管、电生理监测结果、疗效及并发症情况。结果两组责任血管均有小脑前下动脉(anterior inferior cerebellar artery,AICA)、小脑后下动脉(posterior inferior cerebellar artery,PICA)和椎动脉,其中对照组PICA明显多于治疗组(P<0.05)。治疗组发现垫棉压迫面神经REZ 10例,两组均未见静脉压迫。治疗组术中异常肌反应(abnormal muscle response,AMR)消失22例,对照组AMR消失66例,两组差异无统计学意义(P>0.05)。治疗组随访30例,术后症状立即消失26例,随访期内延迟缓解1例,未缓解3例;对照组随访89例,术后症状立即消失65例,随访期内延迟缓解20例,未缓解4例;两组症状缓解率差异无统计学意义(P>0.05)。两组术后并发症主要有面瘫、头痛、听力下降等,其中治疗组头痛发生率及并发症总发生率明显高于对照组(P<0.001)。结论在电生理监测下行二次手术治疗面肌痉挛术后无效或复发病例安全有效。

Objective To evaluate the outcome of reoperation for invalid operation and recurrence of patients with hemifacial spasm and occurrence of complication. Methods The 32 hemifacial spasm patients with invalid operation and recurrence were chosen as the treatment group, and 100 hemifacial spasm patients undergoing the first operation were set as control group. The offending vessels,electrophysical monitoring results, operative outcomes and complications were compared between the two groups. Results The anterior inferior cerebellar artery（AICA）, posterior inferior cerebellar artery（PICA） and vertebral artery were found as offending vessels in the two groups. The PICAs were found more frequently in the control group than in the treatment group（P〈0.05）. Teflon cotton compression was found in 10 patients of treatment group. There was no vein compression in both groups. The abnormal muscle response（AMR） disappeared during operation in 22 patients of the treatment group and in 66 of the control group. There was no significant difference between the two groups in the disappearance of AMR（P〉0.05）. Clinical symptoms disappeared immediately after operation in 26 patients, delayed remission in 1 and invalid in 3 during the follow-up period in 30 cases of the treatment group. Clinical symptoms disappeared immediately after operation in 65 patients and delayed resolution in 20, invalid in 4 during the follow-up period in 89 cases of the control group. There was no significant difference in relief rate of symptoms between the two groups（P〉0.05）. The main complications included facial paralysis, headache and hearing loss in two groups. The rates of headache and total complications were significantly higher in the treatment group than the control group（P〈0.001）. Conclusion The reoperation is safe and effective in the treatment of hemifacial spasm patients with invalid operation and recurrence.