48例面神经微血管减压术的临床分析

doi:10.6040/j.issn.1671-7554.0.2020.0255

摘要/Abstract

摘要： 目的探讨面神经微血管减压术的临床疗效。方法对山东大学齐鲁医院(青岛)神经外科自2014年2月至2018年9月期间进行面神经微血管减压术的48例符合纳入条件的面肌痉挛患者的临床资料进行回顾性分析。对手术有效率、手术并发症率、治疗及恢复情况进行统计,并将治愈患者分为即刻治愈组及延迟治愈组,对两组患者的病程长短、性别、年龄、严重程度、责任血管数量进行比较。结果所有患者均进行随访,无死亡患者。术后即刻治愈35例(72.92%),延迟治愈12.00例(25.00%),1例无效(2.08%),无症状加重患者,总有效率97.92%。对术后影响延迟治愈的因素进行单因素分析,结果显示性别、年龄、疾病分级、责任血管数量差异均无统计学意义(P>0.05),2组病程差异有统计学意义(P=0.039)。术后并发症:头痛17例(35.42%),头晕及恶心27例(56.25%),脑脊液漏2例(4.17%,1例乳突开放,1例刀口漏),体温高7例(14.58%,1例为颅内感染引起),术后不同程度面瘫12例(25%),听力下降7例(14.58%),面部麻木2例(4.17%),除1例(2.08%)患者面瘫及听力下降症状未完全好转外,其余并发症经过对症处理后均完全恢复。结论面神经微血管减压术为治疗面肌痉挛的有效方法;病程长短是延迟治愈的影响因素,病程越长,越容易出现延迟治愈现象。

关键词: 面肌痉挛, 微血管减压, 电生理监测, 责任血管, 延迟治愈

Abstract: Objective To investigate the efficacy of microvascular decompression in the treatment of hemifacial spasm. Methods The clinical data of 48 patients with hemifacial spasm treated in department of neurosurgery during Feb. 2014 and Sep. 2018 were retrospectively analyzed, including the effective rate, complication rate, treatment plan and prognosis. The patients were divided into two groups: immediate cure group and delayed cure group. The length of medical history, gender, age, severity of symptoms, and number of responsible vessels were compared between the two groups. Results All patients were followed up, and no death occurred. Of all patients, 35 cases(72.92%)were immediately cured, 12 cases(25.00%)had delayed recovery, and 1 case(2.08%)was not responsive. No case deteriorated. The overall effective rate was 97.92%. Analysis of the influencing factors of delayed cure showed that there were no significant differences in gender, age, severity of symptoms, and number of responsible vessels between the two groups(P>0.05), while there was significant difference in medical history. Complications included headache in 17 cases(35.42%), dizziness and nausea in 27 cases(56.25%), leakage of cerebrospinal fluid in 2 cases(4.17%), fever in 7 cases(14.58%), facial paralysis in 12 cases(25.00%), and hearing loss in 7 cases(14.58%). All complications were cured except for 1 case with facial paralysis and hearing loss. Conclusion Microvascular decompression is effective in the treatment of hemifacial spasm. Longer length of medical history is associated with delayed cure.

Key words: Hemifacial spasm, Microvascular decompression, Electrophysiological monitoring, Responsible vessel, Delayed cure

中图分类号:

R651.1+1

郭文强,姜彬,和政,黄德章,张红英,殷鑫,王志刚. 48例面神经微血管减压术的临床分析[J]. 山东大学学报 (医学版), 2020, 58(11): 59-64.

GUO Wenqiang, JIANG Bin, HE Zheng, HUANG Dezhang, ZHANG Hongying, YIN Xin, WANG Zhigang. Clinical analysis of microvascular decompression in 48 patients with hemifacial spasm[J]. Journal of Shandong University (Health Sciences), 2020, 58(11): 59-64.

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