不同微血管减压术治疗面肌痉挛的效果比较

Comparison of different microvascular Decompression for Hemifacial Spasm

目的探究不同微血管减压术治疗面肌痉挛的效果。方法选取2017年1月至2019年9月在新乡市中心医院诊断并治疗面肌痉挛患者123例,通过计算机随机分为全程减压组63例,施行从上橄榄上窝上缘的桥延髓沟延伸到脑干表面(第1区)、从脑干分离之前,根附着在脑桥表面(第2区)、逐渐变窄区域(第3区)及神经向远端延伸至内耳道(第4区)共4个区域的全程微血管减压;REZ减压组60例,施行从上橄榄上窝上缘的桥延髓沟延伸到脑干表面(第1区)、从脑干分离之前,根附着在脑桥表面(第2区)及逐渐变窄部分(第3区)共3个区域的微血管减压术。比较两组微血管减压手术(MVD)术后2周内患者症状改善情况、手术时间及术后并发症发生率。采用多因素Logistics回归分析判断影响微血管减压术预后的独立危险因素。结果全程减压组63例患者中,最终优秀率为96.83%(61/63),良好率为3.17%(2/63),无较差结局。REZ减压组术后最终优秀率为91.67%(55/60),良好率为6.67%(4/60),较差率为1.66%(1/60)。全程减压组最终缓解率优于REZ减压组(χ^(2)=4.68,P=0.03)。全程减压组和REZ减压组并发症发生率及手术时间比较,差异无统计学意义[并发症:8.33%vs 6.35%,t=0.11,P=0.94;手术时间:(16.0±2.5)min vs(15.5±2.0)min,t=1.22,P=0.22]。多因素Logistics回归分析显示,手术方式是影响面肌痉挛术后效果的独立影响因素(P=0.03,OR=4.26,95%CI:0.35~5.20)。结论采用全程血管减压术治疗面肌痉挛,能够取得较仅REZ区域减压更好的术后恢复效果。

Objective To investigate the effect of different microvascular decompression in the treatment of hemifacial spasm.Methods From January 2017 to September 2019,123 patients with hemifacial spasm were diagnosed and treated at Xinxiang Central Hospital,total decompression group(63 cases)were randomly divided by computer,the pontobulbar sulcus extending from the superior margin of the superior fossa of the Superior olivary to the surface of the brainstem(area 1),prior to separation from the brainstem,the roots were attached to the surface of Pons(zone 2),gradually narrowed zone(zone 3)and nerves extended to the distal part of the internal auditory canal(zone 4),microvascular decompression was performed in all four regions;60 cases in the REZ decompression group,microvascular decompression was performed from the pontobulbar sulcus extending from the superior margin of the superior fossa of the superior olivary to the surface of the brainstem(area 1),with roots attached to the surface of the pontine(area 2)and gradually narrowed part(area 3)before separation from the brainstem.Two groups of microvascular decompression(MVD)in 2 weeks after the patients with improved symptoms,operation time and postoperative complications.Multivariate logistic regression analysis was used to determine the independent risk factors influencing the prognosis of microvascular decompression.Results In the total decompression group,the final excellent rate was 96.83%(61/63),the good rate was 3.17%(2/63),there was no bad ending.In the REZ decompression group,the final excellent rate was 91.67%(55/60),the good rate was 6.67%(4/60),and the bad rate was 1.66%(1/60).The final remission rate of the complete decompression group was better than that of the REZ decompression group(χ^(2)=4.68,P=0.03).There was no significant difference in the complication rate and operation time between the complete decompression group and the REZ decompression group[complications:8.33%vs 6.35%,t=0.11,P=0.94;Operation time:(16.0±2.5)min vs(15.5±2.0)min,t=1.22,P=0.22].Multivariate logistic regression analysis showed that operation mode was an independent factor affecting the postoperative outcome of hemifacial spasm(P=0.03,OR=4.26,95%CI:0.35~5.20).Conclusion Total vascular decompression for hemifacial spasm is more effective than REZ decompression alone.