切口改良乙状窦后入路在显微血管减压术中的应用

Application of the modified incision in microvascular decompression through retrosigmoid approach for patients with cranial nerve diseases

目的探讨切口改良乙状窦后入路在显微血管减压术(MVD)中的应用效果。方法回顾性分析2018年1月至2020年6月采用MVD治疗的419例颅神经疾病的临床资料,其中2018年1月至2019年4月采用传统乙状窦后入路MVD治疗的227例作为对照组;2019年4月至2020年6月采用改良切口传统乙状窦后入路MVD治疗的192例作为改良组。术后随访至2022年6月。结果对照组体位摆放时间(15.26±3.17)min,手术时间(103.98±8.63)min,总有效率为97.3%,术后总并发症发生率为3.5%;改良组体位摆放时间(5.40±2.04)min,手术时间(91.93±7.11)min,总有效率为97.9%,术后总并发症发生率为2.1%。两组总有效率无统计学差异(P>0.05),但是改良组体位摆放时间和手术时间明显缩短(P<0.05),术后并发症发生率明显降低(P<0.05)。结论切口改良乙状窦后入路MVD治疗颅神经疾病疗效良好,而且节约体位摆放时间,缩短手术时间,术中小脑牵拉轻微、枕动脉保护良好,术后并发症发生率低。

Objective To explore the application effectiveness of the modified incision of the retrosigmoid approach in microvascular decompression(MVD).Methods The clinical data of 419 patients with cranial nerve diseases treated with MVD from January 2018 to June 2020 were retrospectively analyzed.Among them,227 patients treated with MVD through traditional retrosigmoid approach from January 2018 to April 2019 were served as the control group,and 192 patients treated with MVD through modified incision retrosigmoid approach from April 2019 to June 2020 were served as the modified group.Postoperative follow-up was conducted until June 2022.Results In the control group:the positioning time of was(15.26±3.17)min;the operation time was(103.98±8.63)min;the total effective rate was 97.3%;the total postoperative complication rate was 3.5%.In the modified group:the positioning time was(5.40±2.04)min;the operation time was(91.93±7.11)min;the total effective rate was 97.9%;the total postoperative complication rate was 2.1%.There was no significant difference in the total effective rate between the two groups(P>0.05),but the positioning time and operation time of the modified group were significantly shortened(P<0.05),and the postoperative complication rate of the modified group was significantly decreased(P<0.05).Conclusion The modified incision retrosigmoid approach in MVD for cranial nerve diseases has a good therapeutic effect.It saves the positioning time,shortens the operation time,and has mild cerebellar traction during the operation and good protection of the occipital artery,with a low incidence of postoperative complications.