显微血管减压术治疗原发性三叉神经痛疗效的相关因素

doi:10.6040/j.issn.1671-7554.0.2015.1099

摘要/Abstract

摘要： 目的探讨影响显微血管减压术( MVD)治疗原发性三叉神经痛(TN)疗效的相关因素。方法对153例原发性TN患者施行MVD,对临床资料行单因素χ2检验及Logistic多因素回归分析,评价影响MVD治疗原发性TN疗效的独立危险因素。结果 (1)疼痛完全消失125例,疼痛明显缓解26例,未愈2例;(2)103例单纯受动脉压迫,49例合并静脉压迫,1例无明显责任血管,合并静脉压迫的患者术后疼痛完全消除率(71%)较单纯动脉压迫者(81%)低,且差异有统计学意义(P<0.05);(3) V2支疼痛的患者术后疼痛完全消除率(55%)较其他疼痛分布区患者低,差异有统计学意义(P<0.05), 且V2支疼痛的患者,责任血管多自三叉神经的腹侧压迫(50%),且差异有统计学意义(P<0.05);(4)Logistic回归分析显示,静脉压迫和V2支疼痛是影响MVD治疗原发性TN临床疗效的独立危险因素。结论静脉压迫、V2支疼痛的患者术后疗效较差,为独立危险因素;V2支疼痛的患者,其责任血管多自三叉神经腹侧压迫三叉神经,这成为难治性V2支疼痛新的研究方向。

关键词: 疗效分析, 静脉, 上颌支, 三叉神经痛, 显微血管减压术

Abstract: Objective To explore the influencing factors on the curative effect of microvascular decompression(MVD)in the treatment of primary trigeminal neuralgia(TN). Methods MVD was performed in 153 primary TN patients. The independent risk factors on the curative effect were evaluated by single factor analysis of chi-square test and Logistic regression analysis. Results (1) Pain vanished in 125 cases, obviously relieved in 26 cases, and remained unchanged in 2 cases. (2) The artery was compressed in 103 cases, complicated with venous conflict in 49 cases, and 1 case had no obvious conflict. The pain-free rate of venous conflict(71%)was significantly lower than that of artery compression alone(81%, P<0.05). (3) The pain-free rate of V2 was significantly lower than others(P<0.05). Half of the patients with V2 had their NVC at the ventral site of the nerve(P<0.05). (4) Logistic regression analysis showed the vein and V2 were independent risk factors on the curative effect. Conclusion Patients with venous compression or V2 pain have poor curative effect. Venous compression and V2 pain are the independent risk factors. The ventral site is the crucial conflict site of V2, which can serve as a new target for the study of refractory trigeminal neuralgia.

Key words: Primary trigeminal neuralgia, Maxillary branch, Vein, Microvascular decompression, Analysis of curative effect

中图分类号:

R651.1

张斌,张良文,迟令懿,王传伟,朱树干. 显微血管减压术治疗原发性三叉神经痛疗效的相关因素[J]. 山东大学学报（医学版）, 2016, 54(6): 69-72.

ZHANG Bin, ZHANG Liangwen, CHI Lingyi, WANG Chuanwei, ZHU Shugan. Influencing factors on the curative effect of microvascular decompression in the treatment of primary trigeminal neuralgia[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2016, 54(6): 69-72.

参考文献

[1] Von Eckardstein KL, Keil M, Rocjde V.Unnecessary dental procedures as a consequence of trigeminal neuralgia[J]. Neurosurg Rev, 2015, 38(2):355-360.
[2] Elias WJ, Burchiel KJ. Microvascular decompression[J]. Clin J Pain, 2002, 18(1):35-41.
[3] Manzoni GC, Torelli P. Epidemiology of typical and atypical craniofacial neuralgias[J]. Neurol Sci, 2005, 26(Suppl2):65-67.
[4] Sindou M, Leston J, Decullier E, et al. Microvascular decompression for primary trigrminal neuralgia: long-term effectiveness and prognostic factors in a series of 362 consecutive patients with clearcut neurovascular conflicts who underwent pure decompression[J]. J Neurosurg, 2007, 107(6):1144-1153.
[5] Broggi G, Ferroli P, Franzini A, et al. Microvascular decompression for trigeminal neuralgia: comments on a series of 250 cases, including 10 patients with multiple sclerosis[J]. J Neurol Neurosurg Psychiatry, 2000, 68(1):59-64.
[6] Brisman R. Gamma knife radiosurgery for primary management for trigeminal neuralgia[J]. J Neurosurg, 2000, 93(Suppl 3):159-161.
[7] Kakizawa Y, Sequchi T, Kodama K, et al. Anatomical study of the trigeminal and facial cranial nerves with the aid of 3.0-tesla magnetic resonance imaging[J]. J Neurosurg, 2008, 108(3): 483-490.
[8] 张良文, 王萍, 李峰, 等. MVD治疗原发性三叉神经痛(附142例报告)[J]. 山东大学学报(医学版), 2011, 49(3):99-101. ZHANG Liangwen, WANG Ping, LI Feng, et al. Treatment of primary trigeminal neuralgia by microvascular decompression: report of 142 cases[J]. Journal of Shandong University(Health Sciences), 2011, 49(3):99-101.
[9] 任祖东, 李明, 戴荣权, 等. 单独静脉压迫致三叉神经痛的临床特点及手术治疗[J]. 立体定向和功能性神经外科杂志, 2013, 26(5):279-282. REN Zudong, LI Ming, DAI Rongquan, et al. Clinical features and surgical treatment of trigeminal neuralgia compressed by the vein[J]. Chin J Stereotact Funct Neurosurg, 2013, 26(5):279-282.
[10] Dumot C, Sindou M. Trigeminal neuralgia due to neurovascular conflicts from venous origin: an anatomical-surgical study(consecutive series of 124 operated cases)[J]. Neurosurgical Anatomy, 2015, 157(3):455-466.
[11] Lee SH, Levy EI, Scarrow AM, et al. Recurrent trigeminal neuralgia attributable to veins after microvascular decompression[J]. Neurosurgery, 2000, 46(2):356-361.
[12] Kalkanis SN, Eskandar EN, Carter BS, et al. Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes[J]. Neurosurgery, 2003, 52(6):1251-1261.
[13] Sekula RF, Frederickson AM, Jannetta PJ, et al. Microvascular decompression in patients with isolated maxillary division trigeminal neuralgia, with particular attention to venous pathology[J]. Neurosurg Focus, 2009, 27(5): E10. doi: 10.3171/2009.8.FOCUS09142.
[14] Laude M, Legars D, Boudin G, et al. Descriptive anatomy of the posterior root of the trigeminal nerve(preliminary study)[J]. Bull Assoc Anat(Nancy),1976, 60(168):151-158.
[15] 韩兴军, 杜英林, 肖建国, 等. 三叉神经根、Meckel腔内半月神经节及其分支与断层标本对比的解剖学研究[J]. 医学影像学杂志, 2008, 18(7):712-716. Han Xingjun, DU Yinglin, XIAO Jianguo, et al. A comparative study on anatomy of trigeminal nerves trigeminal ganglion in Meckels cavity and their branches with MRI and sectional specimen[J]. J Med Imaging, 2008,18(7):712-716.
[16] Stechison MT, Moller A, Lovely TJ. Intraoperative mapping of the trigeminal nerve root: technique and application in the surgical management of facial pain[J]. Neurosugery, 1996, 38(1):76-81.
[17] Zhang W, Chen M, Zhang W, et al. Trigeminal neuralgia: evaluation of the relationship between the region of neuralgic manifestation and the site of neurovascular compression under endoscopy[J]. J Craniofac Surg, 2015, 26(5):1596-1599.

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