PBC治疗三叉神经痛术中球囊压力与术后并发症、复发的关系研究

Relations of balloon pressures with complications and recurrence in treatment of trigeminal neuralgia by percutaneous balloon compression

目的探讨经皮穿刺球囊压迫术(PBC)治疗三叉神经痛术中球囊压力的变化特点和分期,以及不同时期球囊压力与患者术后面部麻木发生、疼痛复发间的关系。方法前瞻性选择自2019年5月至2020年5月于甘肃省人民医院神经外科行PBC治疗的32例原发性三叉神经痛患者进入研究,术中使用测压仪连接电脑连续记录球囊的压力变化,并依据球囊压力的变化特点将手术分为梨形期、维持期;术后应用巴罗神经病学研究所(BNI)面部麻木强度分级及疼痛强度分级评估患者的面部麻木发生、疼痛复发情况,参照美国临床和实验室标准化协会(CLSI)C28-A2文件推荐的稳健评估法确定梨形期、维持期、全程期(梨形期+维持期)球囊压力的参考范围,并采用Spearman秩相关检验分析梨形期、维持期、全程期球囊压力与术后24 h、12个月面部麻木发生及术后6个月、12个月疼痛复发的相关性。结果32例患者中,术后24 h时疼痛缓解31例,发生患侧面部麻木30例;术后12个月时疼痛复发2例。稳健评估法确定梨形期、维持期和全程期球囊压力的参考范围分别为156.8~126.5 kPa、136.1~117.9 kPa、141.9~119.9 kPa。梨形期、维持期、全程期球囊压力与术后24 h、12个月的面部麻木发生呈正相关关系(P<0.05);梨形期、全程期球囊压力与术后6个月的疼痛复发呈负相关关系(P<0.05),梨形期、维持期、全程期球囊压力与术后12个月的疼痛复发呈负相关关系(P<0.05)。结论PBC术中球囊压力越小术后越容易疼痛复发,压力越大术后越容易发生面部麻木,而维持各时期球囊压力在适当范围(梨形期:156.8~126.5 kPa;维持期:136.1~117.9 kPa;全程期:141.9~119.9 kPa)则可使PBC疗效得到最大化。

Objective To investigate the changing characteristics and stages of balloon pressures in treatment of trigeminal neuralgia by percutaneous balloon compression(PBC),and explore the relations of balloon pressures at different stages with postoperative facial numbness and pain recurrence.Methods A prospective analysis was performed.Thirty-two patients with primary trigeminal neuralgia,admitted to our hospital from May 2019 to May 2020,were chosen.During surgery,a manometer was connected with computer manometry software to continuously monitor the balloon pressure changes;pear-shaped stage and maintenance stage were named during the balloon pressure changes.The facial numbness occurrence and pain recurrence were assessed by Barrow Institute of Neurology(BNI)facial numbness and pain intensity scales.Robust evaluation method referred to American Institute for Clinical and Laboratory Standardization(CLSI)C28-A2 document was used to determine the reference ranges of balloon pressures at the pear-shaped stage,maintenance stage and whole-process stage(pear-shaped stage+maintenance stage).Spearman rank correlation test was used to analyze the correlations of balloon pressures at the pear-shaped stage,maintenance stage and whole-process stage with facial numbness 24 h and 12 months after surgery,and pain recurrence 6 and 12 months after surgery.Results Among the 32 patients,pain relief was found in 31 patients and lateral numbness was found in 30 patients 24 h after surgery.Pain recurred 12 months after surgery in 2 patients.The reference ranges of pressure at pear-shaped stage,maintenance stage and whole-process stage were(157.2-128.5)kPa,(136.10-117.9)kPa and(141.9-119.9)kPa,respectively.The pressures at pear-shaped stage,maintenance stage and whole process stage were positively correlated with facial numbness 24 h and 12 months after surgery(P<0.05);there were negative correlations between pressures at pear-shaped stage and whole-process stage and pain recurrence 6 months after surgery(P<0.05);pressures at pear-shaped stage,maintenance stage and whole-process stage were negatively correlated with pain recurrence 12 months after surgery(P<0.05).Conclusion The lower the balloon pressure during PBC,the more likely it would have pain recurrence after surgery;and the higher the pressure,the more likely it would have facial numbness after surgery;the efficacy of PBC can be maximized when the balloon pressures maintains at adequate ranges([157.2-128.5]kPa at the pear-shaped stage,[136.1-117.9]kPa at the maintenance stage and[141.9-119.9]kPa at the whole-process stage).