【作者】 胡华；

【导师】 黄玮；

【作者基本信息】 广西医科大学 ， 神经外科， 2011， 硕士

【摘要】 目的:探讨微血管减压术治疗原发性三叉神经痛的临床效果及影响手术疗效的相关因素。方法:回顾性分析34例2006年4月至2010年8月期间在广西医科大学第一附属医院神经外科接受微血管减压术治疗的原发性三叉神经痛患者的临床资料。分析34例患者的临床特征、术中所见和术后疗效随访结果。随访时间半年至4年,平均41个月。对可能影响手术疗效的年龄、性别、患侧、病程、临床症状、压迫程度和减压程度等因素进行分析。结果:根据临床特征分为为典型性三又神经痛(23例)和非典型性三叉神经痛(11例)。本组34例病人中术中见单纯动脉压迫28(82.4%)例,包括SCA、AICA、PICA、BA、及SCA+AICA、AICA+PICA等,3例(8.8%)为动脉和静脉血管同时压迫;单纯静脉压迫2例(5.9%),未见明显血管压迫1例(2.9%)。34例患者神经减压程度中,充分减压的27例, 7例部分减压。至随访结束,本组治愈23例(67.6%)、显效8例(23.5%),有效2例(5.9%),无效1例(2.9%),总有效率97.1%。其中23例典型性TN患者中,治愈及显效23例(100%);11例非典型性三叉神经痛患者中,治愈及显效8例(72.7%),有效2例(18。2%),无效1例(9.1%)。两组间疗效比较有统计学意义(P<0.05)。对年龄、性别、患侧、病程、临床症状、神经压迫程度和减压程度进行统计学分提示临床症状、病程、神经压迫程度和减压程度与手术疗效之间有相关性(P<0.05)。结论:微血管减压术,使三叉神经功能可以得到保护,疗效确切,是首选治疗方法。典型性三叉神经痛患者微血管减压术后疗效优于非典型性三叉神经痛患者。影响微血管减压手术疗效的因素主要有临床症状、病程、神经压迫程度和减压程度。更多还原

【Abstract】 Objective:To explore the clinical effect and related factors on the treatment of idiopathic trigeminal neuralgia by microvascular decompression.Methods: The clinical data of 34 patients with idiopathic trigeminal neuralgia treated by microvascular decompression between April 2006 and October 2010 in Guangxi medical univ- ersity first affiliated hospital neurosurgery department were retrospectively analyzed. Analysis of 34 cases of patients with clinical presentation, operative findings and follow -up outcomes. Follow-up time from six months to 6 years, an average of 41 months. Analysed all the factors of influence effect ofoperation prob- ably:the patients’age,gender,affected side,course of disease,clinical presentation,the degree of com- pression and decompression.Results: According to clinical characteristics,divided into typical trigeminal neuralgia group(23 cases)and atypical trigeminal neuralgia group(11 cases).In 34 patients,simple artery compression 28 cases (82.4%), including SCA, AICA, PICA, BA, and SCA+AICA, AICA+ PICA etc, 3 cases (8.8%) for arteries and veins while oppression; simple vein compression 2 cases (5.9%), no significant vascular compression of 1 cases (2.9%). Degree of 34 patients with neural decompression, full de- com- pression in 27 cases, of 7 patients with partial decompression. To the end of follow-up, cure for 23 cases of this group (67.6%), Excellent in 8 cases (23. 5%), effective 2 cases (5. 9%), invalid 1 cases (2. 9%), the total effective rate 97.1%. In 23 patients with typical TN, cure and exce- llent in 23 cases (100%); in 11 cases with atypical trigeminal neuralgia, cure and ex- cellent 8 cases (72.7%), effective 2 cases (18. 2%), invalid 1 cases (9.1%).The effect between the two groups had signifi- cant differ- ence (P<0. 05). Statistical analysis of the factors such as age,gender,affected side,disease course,clinical presentation,the degree of com- pression and decompression,suggested that clinical presentation,the disease course,the degree of compression and decompression were significantly correlated with the effect of surgery(P<0. 05).Conclusion: Microvascular decompression is an etiotropic, safe and effective treatment for idiopathic trigeminal neur- algia. It may be the first choice for healing ITN Microvascular decompression had better eff- ect in pain relief for patients with typical trigeminal neuralgia than pati- ents with atypical trigeminal neuralgia.The main factors affecting the effect of microvascular decompression were clinical presentation , dis- ease course,the degree of compression and decompression.更多还原