原发性三叉神经痛患者经皮微球囊扩张压迫术中球囊投影形状的分析及处理

Analysis and management of abnormal balloon projection shape during percutaneous microballoon compression for the treatment of patients with primary trigeminal neuralgia

目的观察原发性三叉神经痛经皮微球囊压迫术中球囊投影形状及与疗效的关系,分析球囊异常形状并探讨处理方案。方法回顾性分析2018年6月至2019年11月威海市立医院疼痛科收治的原发性三叉神经痛患者96例,性别不限,年龄39~88岁,病史≥6个月。全身麻醉下行经皮穿刺三叉神经半月神经节微球囊压迫治疗,观察球囊充盈后标准侧位的球囊投影形状,"梨形"或"类梨形"为满意的球囊形状;对球囊形状异常者术中分别进行原因分析及调整,评估全麻苏醒后即刻及术后两周内疼痛完全消失患者与术中球囊形状关系。结果96例患者中1例因穿刺失败放弃手术;89例一次性穿刺成功且球囊充盈后为满意的"梨形";6例患者球囊充盈后显示异常形状,其中4例患者通过调整球囊置入深度或调整穿刺方向后获得满意的"梨形"形状,2例患者更改手术方式治疗。所有"梨形"形状患者术后两周内疼痛完全消失,有效率100%。结论对三叉神经微球囊压迫术中球囊投影形状异常者,应适度调整球囊置入深度或穿刺方向进行处理,直至出现满意的"梨形",反复调整仍不能达到满意形态者,可考虑更改手术方式。

Objective To observe the projection shape of balloon during percutaneous microballoon compression(PMC)for the treatment of primary trigeminal neuralgia(TN)and to analyse abnormal shapes and its management.Methods Ninety-six patients with primary TN,both sexes,aged 39-88 years old,and with a history≥6 months in Department of Pain Management of Weihai Municipal Hospital,were retrospectively analyzed from June 2018 to November 2019.All patients were treated with PMC under general anesthesia.The projection shape of balloon full filled was observed in the standard lateral position.The satisfactory shapes were"pear shape"or"pear-like shape".The causes of abnormal balloon shape were analyzed and adjusted respectively during the operation.The relationship between pain disappeared completely and the balloon projection shape during the operation were evaluated within two weeks after the operation.Results The surgery was given up in one patient because of oval puncture failure.Satisfactory"pear shape"was acquired in 89 patients after balloon filled by one time puncturing during the operation.The abnormal shape was showed in the other 6 patients after balloon filled,satisfactory"pear shape"shape was obtained in 4 cases of them after adjusting the depth of balloon placement or adjusting the direction of puncture,and the surgical method was changed in 2 cases of them.All patients with typical"pear-shape"experienced a complete loss of pain within two weeks after operation,and effective rate was 100%.Conclusion The abnormal shape of balloon during PMC for the treatment of primary TN could be solved by adjusting the depth of balloon or the direction of puncture moderately until a satisfactory"pear shape"acquired.The operation mode should be changed if the normal shape of balloon can not be achieved by repeated adjustments.