伽玛刀放射外科联合针灸治疗原发性三叉神经痛的效果研究

Efficacy of Gamma Knife Radiosurgery and Acupuncture Therapy on Primary Trigeminal Neuralgia

目的:比较伽玛刀放射外科联合针灸与显微血管减压术治疗原发性三叉神经痛的临床效果。方法:回顾性分析2016年11月-2018年10月在南昌大学医院完成治疗的原发性三叉神经痛患者93例的临床资料,根据治疗方法的不同,将患者分为对照组(n=45)和研究组(n=48)。比较两组患者的即时止痛率、视觉模拟评分(VAS)、并发症发生率、复发率、住院时间、治疗总时间、治疗总费用以及治疗总有效率。结果:两组患者的即效率、显效率比较,差异均有统计学意义(P<0.05);但两组患者的即时止痛率比较,差异无统计学意义(P>0.05)。两组治疗前及治疗后各时间段VAS评分比较,差异均无统计学意义(P>0.05)。两组治疗后24 h的VAS评分均低于治疗前,差异均有统计学意义(P<0.05)。3年内两组的慢性并发症发生率比较,差异有统计学意义(P<0.05);两组的急性并发症发生率、并发症总发生率比较,差异均无统计学意义(P>0.05)。两组患者3年内复发率比较,差异无统计学意义(P>0.05)。两组住院时间、治疗总时间及治疗总费用比较,差异均有统计学意义(P<0.05)。两组患者3年内的治疗总有效率比较,差异无统计学意义(P>0.05)。结论:显微血管减压术和伽玛刀放射外科联合针灸均能安全有效治疗原发性三叉神经痛患者,对体质好、可耐受全麻手术、有针灸禁忌证的患者,可选择显微血管减压术;而对体质瘦弱、无法耐受全麻手术或抗拒手术、经济困难的患者,可选择伽玛刀联合针灸治疗。

Objective:To compare the clinical effect of gamma knife radiosurgery combined with acupuncture therapy and microvascular decompression in the treatment of primary trigeminal neuralgia.Method:Clinical data of 93 patients with primary trigeminal neuralgia who completed treatment in Nanchang University Hospital from November 2016 to October 2018 were retrospectively analyzed,according to different treatment methods,patients were divided into control group(n=45)and study group(n=48).The immediate analgesic rate,visual analog scale(VAS),complication rate,recurrence rate,length of hospital stay,total duration of treatment,total cost of treatment and total effective rate of treatment were compared between two groups.Result:Comparison of immediate and apparent efficiency between the two groups,the differences were statistically significant(P<0.05).However,there was no statistical significance in the immediate analgesic rate between two groups(P>0.05).There were no significant differences in VAS scores before and after treatment between two groups(P>0.05).The VAS scores of the two groups 24 h after treatment were lower than those before treatment,the differences were statistically significant(P<0.05).Comparison of the incidence of chronic complications between the two groups within 3 years,the difference was statistically significant(P<0.05).There were no significant differences in the acute and total incidence of complications between the two groups(P>0.05).There was no significant difference in the recurrence rate within 3 years between two groups(P>0.05).Comparison of hospital stay,total treatment time and total treatment cost between the two groups,the differences were statistically significant(P<0.05).There was no significant difference in the total effective rate between two groups within 3 years(P>0.05).Conclusion:Both microvascular decompression and gamma knife radiosurgery combined with acupuncture therapy can safely and effectively treat primary trigeminal neuralgia patients,and for patients with good health,can tolerate all-hemp surgery,there are contraindications to acupuncture therapy,microvascular decompression treatment can be chosen,while patients who are weak,cannot tolerate all-hemp surgery or resist surgery,economic difficulties,can choose gamma knife radiosurgery combined acupuncture therapy treatment.