显微血管减压术治疗特发性偏侧面肌痉挛及术中责任血管的判断(附316例报告)

Microvascular decompression in treatment of idiopathic hemifacial spasm and judgment of the responsible vessels(reports of 316 cases)

目的探讨通过微血管减压术(MVD)治疗特发性偏侧面肌痉挛(HFS)的手术效果及术中责任血管的判断。方法回顾性分析采用MVD治疗的316例HFS患者的临床资料,分析手术效果及术中责任血管的判断。结果316例患者中,痊愈269例(85.1%),明显缓解27例(8.5%),部分缓解16例(5.1%),无效4例(1.3%);复发患者有9例(3.1%)。270例异常肌反应(AMR)消失患者的手术有效率为100%,31例AMR未消失患者为67.7%,15例未监测到AMR患者为33.3%。责任血管:小血管压迫组245例,手术有效率为95.1%;椎动脉复合体组71例,手术有效率为88.7%,两组手术有效率进行统计学比较,差异无统计学意义(P=0.052)。结论MVD是HFS的首选治疗方法,术中电生理监测有助于术中责任血管的判断,手术结束依据为减压后AMR消失和术者经验。

Objective To investigate the effect of microvascular decompression(MVD)in the treatment of idiopathic hemifacial spasm(HFS)and the judgment of responsible vessels during operation.Methods The clinical data of 316 patients with HFS treated with MVD were analyzed retrospectively.The effect of operation and the judgment of responsible vessels during operation were analyzed.Results Among 316 patients,269 were cured(85.1%),27 were significantly relieved(8.5%),16 were partially relieved(5.1%),and 4 were ineffective(1.3%).There were 9 patients(3.1%)with recurrence.The operative effective rate was 100%in 270 patients with disappearance of abnormal muscle reaction(AMR),67.7%in 31 patients without disappearance of AMR and 33.3%in 15 patients without monitored AMR.245 cases in the small vessel compression group,the effective rate was 95.1%.There were 71 cases in the vertebral artery complex group,and the operative effective rate was 88.7%.There was no significant difference between the two groups(P=0.052).Conclusions MVD is the first choice for the treatment of HFS.Intraoperative electrophysiological monitoring is helpful to judge the responsible vessels during operation.The end of operation is based on the disappearance of AMR after decompression and the operator’s experience.