微血管减压术与乙状窦后入路舌咽神经切断术治疗舌咽神经痛临床观察

Clinical observation of microvacular decompression and glossopharyngeal neurotomy via retrosigmoid approach in treatment of glossopharyngeal neuralgia

目的探究微血管减压术与乙状窦后入路舌咽神经切断术治疗舌咽神经痛临床疗效。方法回顾性分析我院2014年12月至2016年10月收治的50例舌咽神经痛患者临床资料,统计患者手术治疗方式,并分析手术治疗效果、并发症发生情况及预后情况。结果本组50例患者中,9例行微血管减压术治疗,26例行乙状窦后入路舌咽神经切断术,15例行乙状窦后入路舌咽神经切断术联合微血管减压术,部分缓解3例(6.00%),完全缓解47例(94.00%),总有效率为100%。本组50例患者,术后发生并发症有14例,其中5例术后疼痛,2例声音沙哑,1例小脑出血,4例听力下降,1例咽部有异物感,1例面瘫;术后随访1年,4例听力下降中仅有1例听力未恢复,术后1年仅有1例复发。结论微血管减压术、乙状窦后入路舌咽神经切断术及两种术式联用均可有效治疗舌咽神经痛,临床治疗中需根据有无明确责任血管压迫选用合适的手术方案,从而显著提高患者生活质量。

Objective To investigate the clinical efficacy of microvacular decompression(MVD)and glossopharyngeal neurotomy via retrosigmoid approach in treatment of glossopharyngeal neuralgia.Methods The clinical data of 50 patients with glossopharyngeal neuralgia in our hospital from December 2014 to October 2016 were retrospectively analyzed.The surgical methods of patients were collected.The curative effects,complications and prognosis were analyzed.Results Among 50 patients,there were 9 cases with MVD,26 cases with glossopharyngeal neurotomy via retrosigmoid approach,15 cases with glossopharyngeal neurotomy via retrosigmoid approach and MVD,and there were 3 cases of partial remission(6.00%)and 47 cases of complete remission(94.00%),the total effective rate was 100%;There were 14 cases of postoperative complications in 50 patients,including 5 cases of postoperative pain,2 cases of hoarse voice,1 case of cerebellar hemorrhage,4 cases of hearing loss,1 case of pharynx foreign body sensation,1 case of facial paralysis;During postoperative one-year follow-up,there was 1 case of without hearing recovery in 4 cases of hearing loss,and 1 case of recurrence after surgery for one year.Conclusion Both MVD and glossopharyngeal neurotomy via retrosigmoid approach can effectively treatglossopharyngeal neuralgia.In clinical treatment,it is necessary to select appropriate surgical regimen based on whether having clear compression of offending vessels,so as to significantly increase living quality of patients.