低温等离子汽化消融术和射频热凝术治疗蝶腭神经痛的病例对照研究

Case-control study of low-temperature plasma coblation and radiofrequency thermocoagulation in the treatment of sphenopalatine neuralgia

目的探讨CT引导下蝶腭神经节低温等离子汽化消融术治疗蝶腭神经痛的效果及安全性。方法收集2005年1月至2018年1月经民航总医院和首都医科大学宣武医院收治并接受CT引导下行射频热凝术(热凝组,42例)和低温等离子汽化消融术(等离子组,75例)治疗的117例原发性SPN患者的临床资料行回顾性分析。通过病例复习、电话随访等方式收集数据。比较2组患者的一般资料,术前及术后7 d、术后3、6个月及术后1、2年的疼痛数字评分法(NRS)评分、术后疼痛有效缓解率,术后面部麻木等不良反应发生情况。结果 2组患者术后各时点的疼痛NRS评分较术前均显著降低(均P <0.05)。术后2年时,等离子组NRS评分显著低于热凝组[(2.21±0.27)分比(3.38±0.44)分](P <0.05)。术后2年时等离子组的疼痛有效缓解率显著高于热凝组[85.3%(64/75)比64.3%(27/42)](P <0.05)。等离子组术后7 d、术后3、6个月及术后1、2年面部麻木发生率均显著低于热凝组,差异均有统计学意义(均P <0.05)。所有患者均无严重手术并发症发生。结论射频热凝术和低温等离子汽化消融术均可有效治疗蝶腭神经痛,低温等离子汽化消融术治疗蝶腭神经痛的远期效果优于射频热凝术,术后面部麻木发生率低。

Objective To investigate the efficacy and safety of CT-guided sphenopalatine ganglion-targeted low-temperature plasma coblation on the treatment of sphenopalatine neuralgia(SPN).Methods Clinical data of117 patients with primary SPN treated with CT-guided radiofrequency thermocoagulation(thermocoagulation group,42 cases)and low-temperature plasma coblation(plasma group,75 cases)in Civil Aviation General Hospital and Xuanwu Hospital,Capital Medical University from January 2005 to January 2018 were retrospectively analyzed.The data were recorded via case review,telephone follow-up and so on.The general information,pain numerical rating scale(NRS)scores before surgery and 7 d,3 and 6 months,1 and 2 years after surgery,postoperative pain effective relief rate,postoperative facial numbness and other adverse reactions were compared between the two groups.Results The pain NRS scores of the two groups at each time point after surgery were significantly lower than those before surgery(all P<0.05).At 2 years after surgery,the NRS score of plasma group was significantly lower than that of the thermocoagulation group[(2.21±0.27)vs(3.38±0.44)](P<0.05).At 2 years after surgery,the pain effective relief rate of the plasma group was significantly higher than that of the thermocoagulation group[85.3%(64/75)vs 64.3%(27/42)](P<0.05).The incidences of facial numbness of the plasma group at 7 d,3 and 6 months,1 and 2 years after surgery were significantly lower than those of the radiofrequency group(all P<0.05).No serious complication occurred in all patients.Conclusions Both radiofrequency thermocoagulation and low-temperature plasma coblation can effectively treat SPN.The long-term efficacy of low-temperature plasma coblation is better than that of radiofrequency thermocoagulation and the incidence of postoperative facial numbness of the former is lower.