特发性面肌痉挛术后迟发性面瘫的危险因素分析及预防

Risk Factors Analysis and Prevention of Delayed Facial Paralysis after Surgery for Idiopathic Facial Spasm

目的探讨特发性面肌痉挛(HFS)患者行显微血管减压术(MVD)后发生迟发性面瘫(DFP)的危险因素及预防措施。方法回顾性分析2014年1月至2019年4月武汉大学人民医院神经外科收治的128例特发性HFS且首次行MVD治疗患者的临床资料,按照术后是否发生迟发性面瘫分为两组,其中10例术后发生DFP。对两组患者的一般病历资料[性别、年龄、病程时长、患侧(记录左或右)、吸烟情况、饮酒情况]、既往史(高血压、高血糖)、术中指标(手术时间、术中出血量、责任血管数量及责任血管类型)、术后并发症(DFP)、术前保守治疗方案[口服卡马西平、注射肉毒素、接受中医治疗(包括针灸、中药)]进行比较,分析影响HFS患者术后DFP的危险因素。结果两组患者的性别、年龄、患侧、吸烟、饮酒、高血压、高血糖、手术时间、术中出血量、责任血管数量、责任血管类型、术前保守治疗方案比较差异无统计学意义(P>0.05),两组病程、面神经压痕比例比较差异有统计学意义(P<0.01)。二分类Logistic回归分析结果显示,病程和面神经压痕是影响HFS患者术后发生DFP的危险因素(P<0.05)。结论病程越长,术后DFP的发生率越高;责任血管对面神经有压痕会增加术后DFP的发生风险。

Objective To explore the risk factors and preventive measures of delayed facial paralysis(DFP)caused by microvascular decompression(MVD)for hemifacial spasm(HFS).Methods The clinical information of 128 cases with idiopathic HFS who received MVD treatment for the first time in the Department of Neurosurgery of Renmin Hospital of Wuhan University from Jan.2014 to Apr.2019 were retrospectively analyzed.According to whether DFP occurred after operation,they were divided into two groups,10 of which had postoperative DFP.The general medical records of the two groups of patients[age,gender,duration of disease course,affected side(left or right recorded),smoking and drinking conditions],medical history(hypertension,hyperglycemia),intraoperative indicators(duration of operation,amount of intraoperative hemorrhage,amount and type of responsible blood vessels),postoperative complications(DFP),preoperative conservative treatment scheme[oral carbamazepine,injection of botulinum toxin,treatment with traditional Chinese medicine(including acupuncture,traditional Chinese medicine),etc.]were compared and analyzed to screen out the risk factors of DFP.Results There were no significant differences in gender,age,affected side,smoking,alcohol consumption,hypertension,hyperglycemia,duration of operation,amount of bleeding during operation,number of responsible blood vessels,type of responsible blood vessels and preoperative conservative treatment between the two groups(P>0.05).There were significant differences in the course of disease and proportion of facial nerve indentation between the two groups(P<0.01).Binary Logistic regression analysis results indicated that the disease course and facial nerve indentation were independent risk factors for postoperative DFP(P<0.05).Conclusion The longer the course of disease,the higher the incidence of postoperative DFP is.Indentation of of the responsible vessel on the facial nerve increases the risk of postoperative DFP.