单中心伽玛刀和射频热凝术治疗难治性三叉神经痛的疗效比较

Comparison of single-center gamma knife radiosurgery and radiofrequency thermocoagulation for drug refractory trigeminal neuralgia

目的比较单中心伽玛刀和射频热凝术治疗难治性三叉神经痛的疗效,总结经验。方法回顾性分析412例难治性三叉神经痛病人的临床资料,其中采用伽玛刀治疗285例(伽玛刀组),采用射频热凝术治疗127例(射频热凝组),比较两组病例的有效性和安全性。结果术后3个月,射频热凝组的治愈率、良好率和有效率均高于伽玛刀组(P <0.05)。在超过3个月的随访中,射频热凝组的良好率均高于伽玛刀组(P <0.05),但并发症发生率较高(P <0.001)。生存分析提示在长期随访阶段,射频热凝组的良好率高于伽玛刀组(P=0.001)。回归分析显示:伽玛刀组病人术后面部麻木(OR=4.43,P=0.01,95%CI:1.45～13.53)、病程≤3年(OR=2.18,P=0.04,95%CI:1.03～4.60)以及既往无手术治疗史(OR=0.55,P=0.03,95%CI:0.31～0.95)是疗效良好的正性预测因子。结论伽玛刀治疗难治性三叉神经痛安全无创,并发症少,而射频热凝术的疗效更佳,但并发症多,应根据病情选择合适的手术方式。

Objective To compare the efficacy of single-center gamma knife radiosurgery(GKR) and radiofrequency thermocoagulation(RT) for drug refractory trigeminal neuralgia(DRTN). Methods Clinical data of 421 DRTN patients were analyzed retrospectively.The patients were divided into GKR group(n = 285) and RT group(n = 127). The effectiveness and safety were compared between the 2 groups. Results The cure, favorable effect and response rates in RT group 3 months after surgery were higher than those in GKR group(P < 0.05). The favorable effect rate was higher in RT group than in GKR group during follow-up period of more than 3 months(P < 0.05), but the rate of complications was significantly higher in RT group( P < 0.001). The survival analysis revealed that the favorable effect rate of RT group was higher than that of the GKR group in the long term period of follow-up(P = 0.001). Regression analysis showed that the postoperative facial numbness(OR = 4.43, P = 0.01, 95%CI:1.45-13.53), epilepsy duration equal to and less than 3 years(OR = 2.18, P = 0.04, 95%CI:1.03-4.60) and no surgical procedure(OR = 0.55, P = 0.03, 95%CI:0.31-0.95) were the positive predictors of effective outcome. Conclusions For DRTN, GKR is a safe and noninvasive method with less complication, while RT has better efficacy but more complications. The proper surgical procedure should be chosen according to the patients’ condition.