原发性三叉神经痛的全内镜MVD与显微镜MVD的临床对比研究

Effect of fully neuroendoscopic MVD versus microscopical MVD for primary trigeminal neuralgia

目的 探讨全内镜下显微血管减压术(MVD)与显微镜下MVD治疗原发性三叉神经痛(PTN)的临床效果。方法 选取2018年8月—2021年12月徐州医科大学附属医院神经外科收治的行MVD治疗的PTN患者。根据纳入和排除标准,最终112例患者纳入研究,收集其临床资料进行回顾性分析。将上述患者分为内镜组(n=38)和显微镜组(n=74)。比较2组患者术后疗效、手术时间、责任血管发现率、术后住院时间、复发情况及术后并发症发生情况。结果 内镜组术后治愈率为94.74%(36/38),显微组术后治愈率为66.22%(49/74),2组比较差异有统计意义(P<0.05)。2组复发情况、责任血管发现率及术后住院时间比较,差异有统计学意义(P<0.05);平均手术时间比较,差异无统计学意义(P>0.05)。内镜组术后并发症发生率为10.5%,显微组术后并发症发生率为29.7%,2组比较差异有统计学意义(P<0.05)。结论 全内镜下MVD治疗PTN较显微镜下MVD责任血管发现率更高、术后疗效更好、复发率更低、并发症更少,术后住院时间更短。

Objective To evaluate the effect of fully neuroendoscopic microvascular decompression(MVD)versus microscopical MVD in the treatment of primary trigeminal neuralgia(PTN).Methods Patients with PTN who were admitted to Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University from August 2018 to December 2021 and underwent MVD were selected.According to the including and excluding criteria,112 patients were finally enrolled and their clinical data were retrospectively analyzed.They were divided into two groups:an endoscopic group(n=38)and a microscope group(n=74).Both groups were compared for postoperative effectiveness,duration of surgery,detection rate of the responsible vessels,the length of hospitalization stay,recurrence rate and the incidence of postoperative complications.Results The endoscopic group showed a postoperative cure rate of 94.74%(36/38),which was statistically different from that in the microscope group(66.22%,49/74).There were statistical differences in the recurrence rate,the detection rate of responsible vessels,and the length of postoperative hospitalization stay between the two groups(P<0.05).Meanwhile,no statistical difference was found in the average duration of surgery between the two groups(P>0.05).The endoscopic group presented a postoperative complication rate of 10.5%,which was statistically different from that in the microscope group(29.7%).Conclusions Compared with microscopical MVD,the use of fully neuroendoscopic MVD in the treatment of PTN has a higher detection rate of responsible vessels,and showed better postoperative effectiveness and fewer complications,with a lower recurrence rate,and shorten the length of postoperative hospitalization stay.