球囊压迫术与微血管减压术治疗原发性三叉神经痛的对比研究

Comparison of balloon compression and microvascular decompression in the treatment of primary trigeminal neuralgia

目的:比较球囊压迫术(percutaneous balloon compression,PBC)与微血管减压术(microvascular decompression,MVD)治疗原发性三叉神经痛(primary trigeminal neuralgia,PTN)的临床疗效。方法:选取2018年7月至2020年12月在江西省人民医院接受住院治疗的119例PTN病人,其中接受MVD手术66例(MVD组),接受PBC手术53例(PBC组),并进行了至少2年的随访。每例病人在术前接受3.0 Tesla磁共振成像,以获得三维飞行时间序列(3D-TOF)。之后按照MRI的检查结果,通过3DSlicer软件对所有纳入研究的病人进行三维重建,并按照压迫程度分为I、II、III型,将其与性别、年龄、侧别、发病区域、是否有糖尿病、高血压、发病时长一起纳入MVD和PBC的术后COX比例风险回归模型进行多因素风险分析。通过ROC曲线验证风险因素与预后的相关性,对PTN病人进行亚组分析,根据COX回归模型和Kaplan-Meier曲线评估预后结果。结果:MVD组的立即缓解率为92.4%,复发率为11.5%,3年内总体缓解率为81.8%;PBC组的立即缓解率为96.2%,复发率为21.6%,3年内总体缓解率为75.5%;通过卡方检验比较,发现MVD和PBC在术后立即缓解率、复发率、3年内总体缓解率上差异均无统计学意义。MVD的多因素COX回归模型提示:血管压迫程度与MVD的预后明显相关;PBC的多因素COX回归模型结果显示:血管压迫程度与PBC的预后无关。基于血管压迫程度对PTN病人进行亚组分析,COX回归模型和Kaplan-Meier曲线结果显示:对于I型(无明确血管压迫)PTN病人来说,MVD和PBC的预后无明显差异,对于II+III型(有明确血管压迫)PTN病人来说,MVD的预后优于PBC。结论:血管压迫程度对上述两种手术方式所取得的手术效果有影响,对于I型PTN病人而言,PBC与MVD的术后无明显差异;对于II+III型PTN病人而言,MVD的预后明显优于PBC,对于不同病人的手术方式选择,血管压迫程度是一个重要因素。

Objective:To compare the clinical efficacy of percutaneous balloon compression(PBC)and microvascular decompression(MVD)in the treatment of primary trigeminal neuralgia(PTN).Methods:Total of 119 patients with PTN who were hospitalized at Jiangxi Provincial People's Hospital from July 2018 to December 2020 were included.Among them,66 patients received MVD treatment,and 53 patients underwent PBC treatment.All patients were followed up for a minimum of 2 years.All the patients underwent 3.0 Tesla magnetic resonance imaging before surgery to obtain 3D time series of flight(3D-TOF).Three-dimensional(3D)reconstruction by 3DSlicer software was used to detect the level of compression.Based on the degree of compression,patients were divided into types I,II and III.The postoperative COX proportional-hazards regression model of MVD and PBC included the degree of compression,gender,age,side,lesion location,diabetes mellitus,hypertension,and disease course.Receiver operating characteristic(ROC)curves were used to evaluate the correlation between risk factors and prognosis.Subgroup analysis of PTN patients was performed,and COX regression model and Kaplan-Meier(KM)curve were used for evaluating the prognosis.Finally,subgroup analysis was performed on PTN patients,and the prognostic results were evaluated based on the COX regression model and Kaplan-Meier curve.Results:In the MVD group,the immediate postoperative remission rate was 92.4%,the recurrence rate was 11.5%,and the overall response rate within 3 years was 81.8%.In the PBC group,the immediate postoperative remission rate was 96.2%,the recurrence rate was 21.6%,and the overall response rate within 3 years was 75.5%.Chi-square test showed no significant differences in immediate postoperative remission rate,recurrence rate,and overall remission rate within 3 years between the two groups.The multivariate COX regression model indicated that the degree of vascular compression significantly correlated with the prognosis of patients in the MVD group,whereas it showed no association with the prognosis of patients in the PBC group.Subgroup analysis of PTN patients was performed based on the degree of vascular compression.The COX regression model and Kaplan-Meier curve showed no significant difference in prognosis between MVD and PBC therapy in type I(no definite vascular compression)PTN patients,while patients treated with MVD had a better prognosis than those treated with PBC in type II+III(definite vascular compression)subgroups.Conclusion:For patients with type I PTN,there was no significant difference in therapeutic effect between PBC and MVD therapy.For patients with type II+III,those who underwent MVD treatment demonstrated a significantly better prognosis compared with those who received PBC treatment.The degree of vascular compression is an important factor in the selection of surgical methods for different patients.