射频热凝术与球囊压迫术治疗原发性三叉神经痛的临床疗效比较

Comparison of clinical efficacy between radiofrequency thermocoagulation and balloon compression in the treatment of patients with primary trigeminal neuralgia

目的比较射频热凝术与球囊压迫术治疗原发性三叉神经痛的疗效及安全性。方法选取2019年6月至2019年10月就诊于青岛市市立医院东院疼痛科的原发性三叉神经痛患者40例,年龄41~83岁,性别不限,应用随机数字表法随机分为射频热凝组(n=19)与球囊压迫组(n=21)。射频热凝组局麻下行三叉神经射频热凝治疗,球囊压迫组全麻下行球囊压迫治疗。对两组患者一般资料、术中血液动力学变化、治疗效果、术后并发症及恢复情况进行观察。结果球囊压迫组较射频热凝组患者术中血液动力学更平稳,手术时间更短(P均<0.05);两组患者术后即刻、术后第3个月时疗效比较差异无统计学意义(P均>0.05);两组患者术后第3个月时BNI疼痛评分分级及BNI面部麻木评分分级比较,差异均无统计学意义(P均>0.05);射频热凝组患者术后24 h时BNI面部麻木、咬肌无力、角膜反射发生率均较球囊压迫组高(P均<0.05)。两组患者术后第3个月咬肌无力症状均恢复;射频热凝组患者术后第3个月角膜反射迟钝发生率较球囊压迫组高(P均<0.05);两组患者术后第3日时恢复质量较术前均有明显提高,差异有统计学意义(P均<0.05)。结论射频热凝术与球囊压迫术均为有效治疗原发性三叉神经痛的手术方式,球囊压迫术患者术中血液动力学更平稳,并发症较少,安全性较高。

Objective To compare the efficacy and safety of radiofrequency thermocoagulation and balloon compression in the treatment of primary trigeminal neuralgia.Methods From June 2019 to October 2019,forty patients with primary trigeminal neuralgia,41-83 years old,both sexes,were collected in the Department of Pain Management,East District of Qingdao Municipal Hospital.They were randomly divided into radiofrequency thermocoagulation group(n=19)and balloon compression group(n=21).Radiofrequency thermocoagulation of trigeminal nerve was under local anesthesia in radiofrequency thermocoagulation group,and balloon compression was under general anesthesia in balloon compression group.The baseline data,hemodynamics,surgical efficacy,complications and quality of recovery were analyzed and compared between the two methods.Results The hemodynamics of the patients were more stable and the operation time was shorter in the balloon compression group than those in the radiofrequency thermocoagulation group(all P<0.05).No difference was found in the efficacy immediately and the 3rd month after the operation(all P>0.05).There was no significant difference in the BNI pain score and facial numbness score between the two groups at the 3rd month after the operation(all P>0.05).The incidence rates of BNI facial numbness,masseter weakness and corneal reflex dullness were higher in patients in radiofrequency thermocoagulation group than those in the balloon compression group at 24 hours after the operation(all P<0.05).The symptoms of masseter weakness fully recovered at the 3rd month after the operation in two groups.The incidence rate of dullness of corneal reflex was high at the 3rd month after operation in the radiofrequency thermocoagulation group compared to the balloon compression group(P<0.05).The recovery quality of patients was significantly improved in the two groups at the 3rd day after the operation compared with that before the operation(all P<0.05).Conclusions Radiofrequency thermocoagulation and balloon compression have the same effective methods for the treatment of primary trigeminal neuralgia.The hemodynamics of patients is more stable in balloon compression group with fewer complications and higher safety.