微血管减压与伽玛刀放射外科手术对老年特发性三叉神经痛的疗效比较

The Effect of Microvascular Decompression and Gamma Knife Radiosurgery on Idiopathic Trigeminal Neuralgia in the Elderly

目的:探讨微血管减压与伽玛刀放射外科手术对老年特发性三叉神经痛的疗效差异。方法:选择2013年11月至2015年11月我院接诊的90例特发性三叉神经痛的老年患者,通过手术方式不同分为微血管减压组(n=45)和伽玛刀组(n=45),比较两组术后3个月疗效,并进行12个月随访,记录术前术后视觉模拟评分法(VAS),并记录并发症以及疼痛复发率。结果:两组术后3个月疗效总缓解率比较无显著差异[88.89%(40/45)vs 82.22%(37/45)](P>0.05);两组术后VAS评分较治疗前均得到显著降低(P<0.05),两组术后1个月VAS评分比较无显著差异(P>0.05),但微血管减压组在术后3个月、6个月、9个月、12个月时VAS评分均明显比伽玛刀组低,比较均具有统计意义(P<0.05);两组术后感染、恶心呕吐、耳鸣、面部麻木、听力障碍总发生率比较无显著差异[17.78%(8/45)vs 15.56%(7/45)](P>0.05);在12个月的随访过程中,微血管减压组疼痛复发率明显比伽玛刀组低[11.11%(5/45)vs 28.89%(13/45)],差异具有统计学意义(P<0.05)。结论:微血管减压术和伽马刀放射术均可缓解老年特发性三叉神经痛,但微血管减压术在远期疼痛缓解率和复发率上均优于伽马刀放射术,更利于基础状况良好的老年患者治疗,但对于基础情况较差或不能耐受手术的患者,伽马刀放射术也可以作为较好的姑息治疗术式。

Objective:To investigate the effect of microvascular decompression and gamma knife radiosurgery on idiopathic trigeminal neuralgia in the elderly.Methods:90 patients of idiopathic trigeminal neuralgia in the elderly who received therapy from November 2013 to November 2015 in our hospital were selected.According to different surgical methods,the patients were divided into the microvascular decompression group(n=45)and the gamma knife group(n=45).The curative effect was compared between the two groups after 3 months,and the patients were followed up for 12 months,and the visual analogue scale(VAS)was recorded before and after the operation,and the complication and pain recurrence rate were record.Results:There was no significant difference in the total remission rate between the two groups after 3 months[88.89%(40/45)vs 82.22%(37/45)](P>0.05);the VAS scores in the two groups were significantly lower than those before treatment(P<0.05),there was no significant difference in VAS score between the two groups after operation 1 month(P>0.05),but the VAS scores in the microvascular decompression group were significantly lower than those of the gamma knife group at after operation 3,6,9 and 12 months,the difference was statistically significant(P<0.05);there was no significant difference in the incidence of postoperative infection,nausea,vomiting,tinnitus,facial numbness and hearing impairment between the two groups[17.78%(8/45)vs 15.56%(7/45)](P>0.05);the pain recurrence rate in the microvascular decompression group was significantly lower than those of the gamma knife group at 12 months follow-up[11.11%(5/45)vs 28.89%(13/45)],the difference was statistically significant(P<0.05).Conclusion:Microvascular decompression surgery and gamma knife radiotherapy can relieve senile idiopathic trigeminal neuralgia,but the microvascular decompression remission rate and recurrence rate were better than that of gamma knife radiation in long-term pain,it's more conducive to the treatment of elderly patients with good foundation,But for the basis of poor or can not tolerate surgery,gamma knife radiosurgery also can be used as a good palliative treatment.