全程神经内镜下与显微镜下血管减压术治疗原发性三叉神经痛的效果比较

Comparison of Efficacy of Neuroendoscopic and Microscopic Vascular Decompression in the Treatment of Primary Trigeminal Neuralgia

目的 比较全程神经内镜下血管减压术(NVD)与显微镜下血管减压术(MVD)治疗原发性三叉神经痛(PTN)患者的效果及对患者疼痛介质、氧化应激、复发情况的影响。方法 选取焦作市第二人民医院2019年4月至2021年12月收治的142例PTN患者,根据手术方案分为神经内镜组和显微镜组,各71例。显微镜组接受MVD术治疗,神经内镜组接受NVD术治疗。比较两组临床疗效、疼痛缓解情况[疼痛缓解时间、视觉模拟评分(VAS)]、手术前后疼痛介质[血清降钙素基因相关肽(CGRP)、5-羟色胺(5-HT)、血管活性肠肽(VIP)、神经肽Y(NPY)、P物质(SP)]、氧化应激反应[髓过氧化物酶(MPO)、去甲肾上腺素(NE)、谷胱甘肽过氧化物酶(GSH-Px)、脑源性神经生长因子(BDNF)]及术后并发症、复发情况。结果 术后4周,神经内镜组总有效率(97.18%)高于显微镜组(87.32%)(P<0.05)。神经内镜组疼痛缓解时间短于显微镜组,血清CGRP、5-HT水平高于显微镜组,VAS评分和VIP、NPY、SP、MPO、NE水平低于显微镜组,GSH-Px、BDNF水平高于显微镜组(P<0.05)。神经内镜组术后并发症发生率(7.04%)、随访1 a复发率(4.23%)低于显微镜组(19.72%、14.08%)(P<0.05)。结论 与MVD术比较,NVD治疗PTN效果更好,可减轻手术创伤氧化应激反应,缓解疼痛,减少术后并发症和复发的发生。

Objective To compare the effect of neuroendoscopic vascular decompression(NVD)and microscopic vascular decompression(MVD)in the treatment of patients with primary trigeminal neuralgia(PTN),and the effects on pain mediators,oxidative stress and recurrence in patients.Methods A total of 142 patients with PTN admitted to the Second People’s Hospital of Jiaozuo City from April 2019 to December 2021 were selected and divided into neuroendoscope group and microscope group according to the operation scheme,with 71 cases in each group.The microscope group received MVD surgery,while the neuroendoscopic group received NVD surgery.The efficacy,pain relief situation[pain relief time,visual analog score(VAS)],pain mediators before and after surgery[serum calcitonin gene-related peptide(CGRP),5-hydroxytryptamine(5-HT),vasoactive intestinal peptide(VIP),neuropeptide Y(NPY),substance P(SP)],oxidative stress response[myeloperoxidase(MPO),norepinephrine(NE),glutathione peroxidase(GSH-Px),brain-derived nerve growth factor(BDNF)],postoperative complications and recurrent condition were compared between neuroendoscope group and microscope group.Results After 4 weeks of surgery,the total effective rate(97.18%)in the neuroendoscope group was higher than that in the microscope group(87.32%)(P<0.05).The pain relief time of the neuroendoscopic group was shorter than that of the microscope group,and the serum levels of CGRP and 5-HT were higher than those of the microscope group,the VAS score and VIP,NPY,SP,MPO,NE levels were lower than those of the microscope group,while the levels of GSH-Px and BDNF were higher than those of the microscope group(P<0.05).The incidence of postoperative complications(7.04%)and 1-year follow-up recurrence rate(4.23%)in the neuroendoscopic group were lower than those in the microscope group(19.72%,14.08%)(P<0.05).Conclusion Compared with MVD surgery,NVD has a better therapeutic effect on PTN,and reduce oxidative stress response to surgical trauma,alleviate pain,reduce postoperative complications and recurrence.