| 华春晖,李心远,刘 春,黄振宇,孟佑强.改良微血管减压术治疗复发性三叉神经痛的疗效及安全性分析[J].,2017,17(27):5358-5361 |
| 改良微血管减压术治疗复发性三叉神经痛的疗效及安全性分析 |
| Analysis of the Clinical Effect and Safety of Modified Microvascular Decompression on the Recurrent Trigeminal Neuralgia |
| 投稿时间：2016-11-21 修订日期：2016-12-19 |
| DOI：10.13241/j.cnki.pmb.2017.27.040 |
| 中文关键词: 复发性三叉神经痛 微血管减压术 全程减压 脑干延伸段 |
| 英文关键词: Recurrent trigeminal neuralgia Microvascular decompression Whole journey decompression Extended segment of brainstem |
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| 中文摘要: |
| 摘要 目的：探讨改良微血管减压术(MVD)治疗复发性三叉神经痛的疗效及安全性。方法：回顾性分析2010年至2015年收治的50例复发性三叉神经痛患者，2012年前采取常规MVD手术方法(MVD组，n=22)，2012年后采取改良MVD的手术方法(改良MVD组，n=28)。MVD组采用传统MVD对三叉神经根进行全程减压，即沿首次切口入路，依次切开皮下、肌筋膜，充分分离骨窗边缘的瘢痕组织，适当扩大骨窗直至硬脑膜充分暴露。切开硬膜，锐性分离蛛网膜后探查Meckel腔至神经出脑区(REZ)，仔细探查三叉神经全段，分离压迫神经的责任血管以及首次手术置入的Teflon垫棉，对三叉神经进行全程减压。改良MVD组在此基础上，探查三叉神经颅内段及其周围结构，解剖三叉神经脑干延伸段，垫开小脑上动脉对三叉神经脑干延伸段的压迫。比较两组术后缓解率、并发症、复发情况。结果：改良MVD组术后缓解率为100.0%，显著高于MVD组72.7% (P<0.05)；两组术后并发症的发生率比较差异无统计学意义(P>0.05)；改良MVD组术后1年复发率为0%，显著低于MVD组22.7% (P<0.05)。结论：MVD术中三叉神经根全程减压联合脑干延伸段减压治疗复发性三叉神经痛患者可有效缓解疼痛，降低术后复发风险，且不增加术后并发症。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the clinical effect and safety of modified microvascular decompression(MVD) on the recurrent trigeminal neuralgia. Methods: 50 patients with recurrent trigeminal neuralgia from 2010 to 2015 in the Center of Cranial Nerve of Shanghai Jiaotong University(including Shanghai Tongren Hospital and Xinhua Hospital) were retrospectively analyzed, patients before 2012 were given regular MVD (MVD group, n=22), patients after 2012 were given improved MVD (modified MVD group, n=28). MVD group was given trigeminal nenre root decompression by traditional MVD, the method was described as follows: the skin, myofascial was cutted in turn along the first incision, the scar tissue on the edge of bone window was separated, and the bone window was appropriately expanded until the dura mater was fully exposed. Then dura mater was cutted open to sharply dissect the arachnoid, Meckel cavity was probed up to neurological brain regions (REZ), the trigeminal nerve segment was closely examined to separate the responsible blood ves- sels of oppressive nerve and the Teflon pad of cotton imbedding at the first operation. Modified MVD group was given detection of in- tracranial trigeminal nerve and its surrounding structures, dissection of brainstem extended segment of trigeminal neuralgia, and the com- pression of superior cerebellar artery to brainstem extended segment of trigeminal neuralgia was fended off. The postoperative remission rate, recurrence and complications between two groups were compared. Results: The postoperative remission rate in modified MVD group was 100.0%, which was significantly higher than that of the MVD group (P<0.05). There was no statistical significance in the inci- dence of postoperative complications between two groups(P>0.05). The recurrence rate at 1 year after surgery in modified MVD group was 0%, which was significantly lower than that of the MVD group(22.7%, P<0.05). Conclusion: Decompression of trigeminal nenre- rootcombined with brainstem extended segment of trigeminal neuralgia in MVD for recurrent trigeminal neuralgia could effectively relieve the pain, reduce the risk of postoperative recurrence, and wouldn't increase the postoperative complications. |
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