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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (1): 28-33.doi: 10.6040/j.issn.1671-7554.0.2020.0686

• 临床医学 • 上一篇    下一篇

伽玛刀与微血管减压术治疗原发性三叉神经痛的疗效比较

王亮亮1,张铭1,孙振伟1,丁守銮2,樊跃飞1,王成伟1   

  1. 山东大学第二医院 1. 神经外科;2. 基础医学研究所循证医学中心, 山东 济南 250033
  • 发布日期:2021-01-09
  • 通讯作者: 王成伟. E-mail:wangchengwei@sdu.edu.cn

Comparison of efficacy of gamma knife radiosurgery and microvascular decompression in the treatment of primary trigeminal neuralgia

WANG Liangliang1, ZHANG Ming1, SUN Zhenwei1, DING Shouluan2, FAN Yuefei1, WANG Chengwei1   

  1. 1. Department of Neurosurgery;
    2. Center of Evidence-Based Medicine, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
  • Published:2021-01-09

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摘要： 目的 伽玛刀放射治疗(GKS)和微血管减压术(MVD)是原发性三叉神经痛(PTN)的主要治疗方式,本研究比较两者的治疗效果和安全性。 方法 收集自2016年以来收治的76例PTN患者(GKS 40例,MVD 36例)治疗资料,并进行最长达40个月的随访,将收集的数据运用t检验、Wilcoxon符号秩和检验等统计学方法分析,评估两种治疗方式的疗效和并发症发生率。 结果 在GKS组和MVD组中,术前BNI与术后BNI分级的差异均有统计学意义(GKS:Z=-5.069,P<0.001;MVD:Z=-5.292,P<0.001)。GKS疼痛缓解的起效时间明显较MVD长［分别为(75.00±115.50)d、(2.00±0.00)d］,其差异有统计学意义(U=248.5,P<0.001),而且MVD患者疼痛缓解程度与GKS的差异有统计学意义(U=500,P=0.013)。MVD的并发症发生率(38.9%)高于GKS(20.0%),但两组间的差异无统计学意义(χ2=3.287,P=0.070)。两种治疗方式的花费差异有统计学意义［GKS(12 236±1 831)元,MVD(37 671±5 221)元,U=2.0,P<0.001］。 结论 GKS和MVD均为治疗三叉神经痛的有效措施,MVD可以获得即刻的疼痛缓解,其手术风险和花费均高于GKS治疗,而GKS是一种安全微创的治疗方式,患者需继续承受疼痛缓解之前的等待过程。因此对于PTN的治疗需要根据患者的具体情况制定个体化综合的治疗方案。

关键词: 伽玛刀, 微血管减压术, 三叉神经痛, 放射治疗

Abstract: Objective To compare the efficacy and safety of gamma knife surgery(GKS)and microvascular decompression(MVD)for primary trigeminal neuralgia(PTN). Methods A total of 76 patients with PTN were included in this study since 2016(GKS: 40 cases, MVD: 36 cases). The maximum follow-up lasted for 40 months. The efficacy and complication rate of the two treatment methods were evaluated with t-test and Wilcoxon signed rank sum test. Results The difference between preoperative and postoperative BNI was statistically significant(GKS: Z=-5.069, P<0.001; MVD: Z=-5.292, P<0.001). The pain relief effect time after GKS was significantly longer than that after MVD ［GKS:(75.00±115.50)days; MVD:(2.0±0.00)days］, and the difference was statistically significant(U=248.5, P<0.001). There was significant difference in the degree of pain relief between the MVD group and GKS group(U=500, P=0.013). The complication rate of MVD(38.9%)was higher than that of GKS(20.0%), but the difference was not statistically significant(χ2=3.287, P=0.070). There was statistically significant difference in the costs ［GKS:(12 236±1 831)yuan, MVD:(37 671±5 221)yuan, U=2.0, P<0.001］. Conclusion Both GKS and MVD are effective measures in the treatment of PTN. MVD can obtain immediate pain relief but it has higher surgical risks and costs than GKS. As a safe and minimally invasive treatment, GKS takes a long time for pain relief. Individualized, comprehensive treatment plans should be developed according to the specific conditions of patients.

Key words: Gamma knife, Microvascular decompression, Trigeminal neuralgia, Radiosurgery

中图分类号: 

  • R651.1+9
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