不同分支三叉神经痛患者显微血管减压术后的疗效分析(附200例报告)

Outcome analysis of microvascular decompression in patients with trigeminal neuralgia involving different branches:A report of 200 cases

目的观察不同分支三叉神经痛(TN)患者显微血管减压术(MVD)后的疗效,分析影响预后的相关因素。方法回顾性分析2017年1月至2018年9月中南大学湘雅医院神经外科行MVD的TN患者的临床资料,共200例。其中疼痛累及范围位于三叉神经第1支(V1)分布区者7例,第2支(V2)分布区者23例,第3支(V3)分布区者27例,V1~V2分布区者29例,V2~V3分布区者64例,V1~V3分布区者50例。术后1个月、3个月、1年采用巴罗神经学研究所(BNI)疼痛强度评分标准评估疼痛缓解情况。分析影响疼痛缓解率的相关影响因素。结果200例患者中,术后1个月、3个月、1年的疼痛缓解率分别为91.5%(183例)、83.0%(166例)及67.0%(134例);其中166例累及分支包含V2支组的上述3个时间点的疼痛缓解率分别为89.8%(149例)、81.3%(135例)及64.5%(107例),34例累及分支未包含V2支组的疼痛缓解率分别为100.0%(34例)、91.2%(31例)、79.4%(27例)。两组比较,术后1年的疼痛缓解率差异有统计学意义(P=0.012)。多因素logistic回归分析结果显示,累及分支包含V2支是TN患者MVD后疼痛缓解的独立危险因素(OR=0.688,95%CI:0.474~0.996,P=0.048)。结论累及分支包含V2支的TN患者,MVD后疼痛缓解率相对低于未累及者。

Objective To observe the therapeutic effect of microvascular decompression(MVD)in patients with trigeminal neuralgia(TN)involving different branches,and to analyze the relevant factors affecting the outcomes.Methods The clinical data of 200 patients with TN who underwent MVD at Department of Neurosurgery,Xiangya Hospital,Central South University from January 2017 to September 2018 were retrospectively analyzed.Among them,the first branch of the trigeminal nerve(V1)was involved in 7 cases,the second branch(V2)in 23,the third branch(V3)in 27,V1&2 in 29,V2&3 in 64,and V1-3 in 50.At 1 month,3 months,and 1 year post operation,BNI(Barrow Neurological Institute)pain intensity scoring criteria were used to assess pain relief and related factors affecting the rate of pain relief were analyzed.Results Among all 200 patients,the pain relief rates at 1 month,3 months,and 1 year post surgery were 91.5%(183 cases),83.0%(166 cases),and 67.0%(134 cases)respectively.In 166 patients with branch involvement of V2,the pain relief rates at 1 month,3 months,and 1 year post surgery were 89.8%(149 cases),81.3%(135 cases),and 64.5%(107 cases)respectively;the remaining 34 cases whose pain symptoms were not related to V2 had the pain relief rates of 100.0%(34 cases),91.2%(31 cases),and 79.4%(27 cases)respectively.The difference in pain relief rate between the two groups was statistically significant at 1 year post operation(P=0.012).Multivariate logistic regression analysis showed that the branch involvement of V2 was the independent influencing factors of pain relief post MVD in patients with TN(OR=0.688,95%CI:0.474-0.996,P=0.048).Conclusion The pain relief rate of TN patients with involvement of V2 seems lower than that of TN patients without V2 involvement.