显微血管减压术治疗面肌痉挛术中AMR复现和AMR稳定消失患者疗效的比较

Comparison of treatment efficacies of microvascular decompression in hemifacial spasm patients with recurrent abnormal muscle response and stably disappeared abnormal muscle response

目的比较显微血管减压术(MVD)治疗面肌痉挛(HFS)术中异常肌反应(AMR)稳定消失和AMR复现患者的疗效,探讨术中关闭硬脑膜后本已消失的AMR再次出现时的处理策略。方法选择国家卫健委中日友好医院神经外科自2014年1月至2019年1月行MVD治疗且术中全程监测、手术结束时复查AMR的1705例HFS患者,根据患者术中AMR的监测结果,将患者分为AMR稳定消失组和AMR复现组。全部患者随访12~68个月,比较2组患者延迟治愈率和总治愈率的差异。结果AMR稳定消失组(1158例)患者中术后即刻治愈1086例,术后0.2~3个月治愈48例,无效24例。AMR复现组(547例)患者中术后即刻治愈301例,术后0.5~6个月治愈232例,无效14例。2组患者的总治愈率(97.9%vs.97.4%)差异无统计学意义(P>0.05),但AMR复现组患者的延迟治愈率明显高于AMR稳定消失组(42.4%vs.4.1%),差异有统计学意义(P<0.05)。手术结束时复查AMR显示,AMR复现组中294例患者在无颅内干预的情况下AMR再次消失,253例患者在手术结束时AMR仍持续存在。结论MVD治疗HFS患者术中彻底减压后,本已消失的AMR再次出现时不需要立即重新手术探查减压,仍可保证优良疗效,患者有较大概率获得延迟治愈,对其疗效评价应至少延长至术后1年。

Objective To compare the treatment efficacy of microvascular decompression(MVD)in hemifacial spasm(HFS)patients with stable disappearance of abnormal muscle response(AMR)and recurrence of AM.Methods A total of 1705 HFS patients who received MVD and accepted AMR monitoring during the whole process were selected in our hospital from January 2014 to January 2019.According to the intraoperative AMR monitoring results,these patients were divided into AMR stable disappearance group and AMR recurrence group.All patients were followed up for 12-68 months;the delayed cure rate and total cure rate were compared between the two groups.Results Among the 1158 patients from AMR stable disappearance group,1086 patients were cured immediately after surgery,48 were cured within 0.2-3 months of surgery,and 24 patients were not effective.Among the 547 patient from AMR recurrence group,301 patients achieved immediate cure after surgery,232 patients had delayed cure in the follow up period(ranged from 0.5 to 6 months),and 14 patients were not effective.The total cure rate showed no significant difference between the two groups(97.9%vs.97.4%,P>0.05),but the delayed cure rate in patients from AMR recurrence group was significantly higher than that from AMR stable disappearance group(42.4%vs.4.1%,P<0.05).Re-examination of AMR at the end of surgery showed that AMR disappeared again in 294 patients from the AMR recurrence group without intracranial intervention,and AMR continued to exist in 253 patients at the end of surgery.Conclusion After complete intraoperative decompression of HFS by MVD,the AMR recurrence does not require immediate re-operative exploration and decompression,which can still ensure excellent curative effect and has a relatively high probability of delayed cure;and the evaluation of its curative effect should be extended to at least one year after surgery.