三叉神经节温控射频术与无水乙醇毁损术治疗原发性三叉神经痛的疗效比较

Comparison of the efficacy between radiofrequency thermocoagulation and absolute alcohol chemical lysis on trigeminal ganglion in the treatment of primary trigeminal neuralgia

目的 比较数字减影血管造影(DSA)引导下半月神经节温控射频热凝术和无水乙醇化学毁损术治疗原发性三叉神经痛的疗效.方法 原发性三叉神经痛患者97例,采用随机数字表法分为无水乙醇组(n=47)和温控射频组(n=50),其中无水乙醇组患者行无水乙醇半月神经节化学毁损术,温控射频组患者行半月神经节温控射频热凝术.分别记录两组患者术前及术后3d、7d、3个月、6个月时VAS评分,及面部感觉减退和咀嚼肌无力情况.结果 与治疗前比较,两组VAS评分均明显下降(P＜0.05);治疗后3d及6个月时,温控射频组患者VAS评分(1.6±1.2、1.3±1.4)显著低于无水乙醇组(2.8±2.0、2.7±2.0)(P＜0.05);疼痛缓解率温控射频组(96.0％、94.0％)高于无水乙醇组(74.5％、72.3％)(P＜0.05);治疗后7d及3个月时面部感觉减退发生率温控射频组(54.0％、40.0％)显著低于无水乙醇组(97.9％、74.5％)(P＜0.05);治疗后3d、7d及3个月时咀嚼肌无力发生率温控射频组(18.0％、18.0％、10.0％)显著高于无水乙醇组(2.1％、4.3％、0)(P＜0.05).治疗后7d及3个月时两组患者VAS评分和疼痛缓解率,治疗后3d及6个月时面部感觉减退发生率,治疗后6个月时咀嚼肌无力发生率两组差异无统计学意义(P＞0.05).结论 DSA引导下半月神经节温控射频热凝术较无水乙醇毁损术治疗原发性三叉神经痛起效快,并发症相对较少,远期效果亦优于无水乙醇化学毁损术.

Objective To compare the efficacy between radiofrequency thermocoagulation and absolute alcohol chemical lysis in the treatment of primary trigeminal neuralgia.Methods Ninety-seven patients with primary trigeminal neuralgia were divided into two groups using a random number table:absolute alcohol group (n=47) and radiofrequency group (n=50).All patients were punctured to trigeminal ganglion under the guidance of DSA.The patients were injected absolute alcohol to trigeminal ganglion in absolute alcohol group,and radiofrequency thermocoagulation to trigeminal ganglion in radiofrequency group.VAS was recorded at pretreatment,and at 3 days,7 days,3 months and 6 months after the treatment.The occurrence of facial hypoesthesia and masticatory muscle weakness were also recorded.Results VAS was lower in radiofrequency group(1.6± 1.2,1.3± 1.4)than that in absolute alcohol group (2.8±2.0,2.7±2.0) at 3 days and 6 months after the treatment,and pain relief rate was higher in radiofrequency group (96.0％,94.0％) than that in absolute alcohol group (74.5％,72.3％) (P＜0.05).The incidence of facial hypoesthesia was lower in radiofrequency group (54.0％,40.0％) at 7 days and three months after the treatment than that in absolute alcohol group (97.9％,74.5％) (P＜0.05).The occurrence of masticatory muscle weakness in radiofrequency group(18.0％,18.0％,10.0％)at 3,7 days and three months after the treatment was higher than that in absolute alcohol group (2.1％,4.3％,0) (P＜0.05).No significant difference was found in VAS and pain relief rate at 7 days and three months after the treatment between the two groups (P＞0.05).The incidence of facial hypoesthesia between the two groups had no significant difference at 3 days and six months after the treatment (P＞0.05).The incidence of nasticatory muscle weakness between the two groups had no significant difference at 6 months after the treatment (P＞0.05).Conclusion DSA guided trigeminal ganglion radiofrequency thermocoagulation ablation is an effective method for the treatment of primary trigeminal neuralgia with rapid onset,long-term effect and relatively few complications,which is superior to absolute alcohol chemical lysis.