显微血管减压术治疗原发性舌咽神经痛的临床疗效及影响因素分析

Clinical efficacy and influencing factor analysis of microvascular decompression for primary glossopharyngeal neuralgia

目的探讨显微血管减压术治疗原发性舌咽神经痛(GPN)的有效性、安全性及其疗效的影响因素。方法回顾性分析2014年1月至2019年11月于北京大学人民医院神经外科接受显微血管减压术治疗的61例原发性GPN患者的临床资料。应用巴罗神经学研究所(BNI)疼痛强度评定量表评估患者治疗前、后的疼痛程度。采用Friedman检验和Wilcoxon符号秩和检验分析术前与术后疼痛程度等级的变化。应用单因素分析和多因素logistic回归分析探讨影响术后疼痛缓解程度的潜在因素并建立回归模型,并采用Hosmer-Lemeshow检验评价模型的拟合优度。结果61例患者中,术后即刻疼痛完全缓解52例(85.2%),明显缓解4例(6.6%),部分缓解3例(4.9%),未获缓解2例(3.3%)。术后2年,疼痛完全缓解41例(67.2%),明显缓解7例(11.5%),部分缓解9例(14.7%),未获缓解4例(6.6%)。术后即刻和术后2年时患者的BNI疼痛强度分级均较术前显著改善,差异均有统计学意义(均P<0.01)。多因素logistic回归分析结果显示,低程度的神经血管压迫(OR=9.29,95%CI:1.87~46.15,P=0.006)和责任血管为静脉(OR=10.53,95%CI:1.91~58.22,P=0.007)是原发性GPN显微血管减压术后疼痛缓解的独立危险因素。Hosmer-Lemeshow检验提示,根据独立危险因素所建立模型的拟合度良好(χ^(2)=0.56,P=0.453)。4例(6.6%)患者术后出现永久性并发症,其中咽部异物感2例(3.3%),声音嘶哑1例(1.6%),患侧轻度听力下降1例(1.6%)。结论显微血管减压术能有效、安全地缓解原发性GPN患者的疼痛症状,但有一定的复发概率。伴有较低程度的神经血管压迫和责任血管为静脉的原发性GPN患者接受显微血管减压术后其疼痛不易缓解。

Objective To investigate the effectiveness,safety and factors influencing the efficacy of microvascular decompression for the treatment of primary glossopharyngeal neuralgia(GPN).Methods The clinical data of 61 patients with GPN who underwent microvascular decompression at the Department of Neurosurgery,Peking University People′s Hospital from January 2014 to November 2019 were retrospectively analyzed.The Barrow Neurological Institute(BNI)pain intensity scale was applied to assess the pain degree of all patients before and after treatment.Friedman′s test and Wilcoxon signed-rank sum test were used to analyze the changes in pain level before and after surgery.Univariate analysis and multivariate logistic regression analysis were used to explore the potential factors affecting postoperative pain relief,and a regression model was established.Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Results Among the 61 patients,52 patients(85.2%)had complete relief of pain immediately after surgery,4 patients(6.6%)had significant relief,3 patients(4.9%)had partial relief,and 2 patients(3.3%)had no relief.Two years after operation,41 cases(67.2%)of pain were completely relieved,7 cases(11.5%)were significantly relieved,9 cases(14.7%)were partially relieved,and 4 cases(6.6%)were not relieved.The BNI pain intensity scores of patients immediately after operation and 2 years after operation were significantly improved compared with those before operation,and the differences were statistically significant(both P<0.01).Multivariate logistic regression analysis showed that low-grade neurovascular compression(OR=9.29,95%CI:1.87-46.15,P=0.006)and venous compression(OR=10.53,95%CI:1.91-58.22,P=0.007)were independent risk factors for pain relief after MVD for GPN.The Hosmer-Lemeshow test indicated that the model based on independent risk factors had a good fit(χ^(2)=0.56,P=0.453).Permanent complications occurred in 4 patients(6.6%),including 2 patients(3.3%)with pharyngeal foreign body sensation,1 patient(1.6%)with hoarseness,and 1 patient(1.6%)with ipsilateral mild hearing loss.Conclusions Microvascular decompression can effectively and safely relieve the pain symptoms of GPN patients,but there is a certain probability of recurrence.Patients with GPN with mild neurovascular compression and venous compression are less likely to experience pain relief after microvascular decompression.