【作者】 邵建锋；

【导师】 罗蔚锋；

【作者基本信息】 苏州大学 ， 神经病学， 2012， 硕士

【摘要】 目的：探讨A型肉毒毒素（botulinum toxin type A，BTX-A）与微血管减压术（microvascular decompression，MVD)治疗原发性三叉神经痛（idiopathic trigeminalneuralgia，ITN）的疗效。方法：收集44例原发性三叉神经痛患者，其中24例三叉神经痛患者行A型肉毒毒素治疗（肉毒毒素治疗组)，20例三叉神经痛患者行微血管减压术治疗(微血管减压术组)。对这两种方法的治疗效果进行分析。用视觉模拟评分（Visual AnalogScores,VAS）进行疼痛测评。结果：1、BTX-A组治疗前VAS评分为9.00±0.88，注射后1周为5.33±3.38，注射后2周为3.08±2.24，注射后1月为2.00±2.21，注射后3月为3.42±2.76，注射后6月为5.88±2.95，治疗前后比较，差异有统计学意义（P＜0.001）。MVD组术前VAS评分为8.95±0.83，术后1周为2.30±2.23，术后2周为0.85±1.09，术后1月为0.30±0.73，术后3月为0.10±0.45，术后6月为0.1±0.45，治疗前后比较，差异有统计学意义（P＜0.001）。两组间比较差异有显著统计学意义。2、并发症：肉毒毒素组主要为一过性口角歪斜、眼睑闭合不全3例，4～6周后自行恢复。微血管减压术组主要有：头晕3例，听力丧失1例；局部面部麻木1例；术后出现小脑出血、第四脑室受压等严重并发症1例，需再次开颅行血肿清除术，出院前痊愈，遗留有面部麻木。两组均无死亡病例。3、对微血管减压术20例患者进行术后随访，随访时间6月～3年，其中3例复发，复发率为15.0％。肉毒毒素组治疗6个月后疗效明显减退，甚至疼痛反复需要再次进行注射治疗，并且显示再次注射治疗有效。结论：1、A型肉毒毒素治疗原发性三叉神经痛安全、有效，但疗效持续时间相对于微血管减压术较短。2、微血管减压术治疗原发性三叉神经痛治愈率高，疼痛缓解率优于肉毒毒素治疗，复发率低，但有一定的严重并发症。3、对于常规药物治疗效果差、术后复发患者、存在手术禁忌症或是害怕手术的原发性三叉神经痛患者，尤其是年龄高、手术风险大的患者，注射A型肉毒毒素治疗是一种可供选择的治疗方法。更多还原

【Abstract】 Objective：To compare the effects of botulinum toxin type A and microvasculardecompression in the treatment of idiopathic trigeminal neuralgia.Methods：Forty-four patients with idiopathic trigeminal neuralgia were involved in thestudy，Twenty-four patients were treated by botulinum toxin type A while twenty patientsreceived the surgery of microvascular decompression. Visual analog scores (VAS) wasused to evaluate the effects of these two treatment by measuring the degree of pain.Results：1、The VAS was9.00±0.88before the BTX-A treatment. The scoresdecreased to5.33±3.38,3.08±2.24，2.00±2.21,3.42±2.76and5.88±2.95at one week,two weeks, one month, three months and six months after the treatment. The effects ofVAS in the treatment of idiopathic trigeminal neuralgia was considered as statisticallysignificant (p<0.001). The VAS was8.95±0.83before the surgery of MVD. The scoreswere2.30±2.23,0.85±1.09，0.30±0.73，0.10±0.45and0.10±0.45at one week, twoweeks, one month, three months and six months after the surgery, respectively. The surgeryof MVD showed significant effects to alleviate the pain from the patients with idiopathictrigeminal neuralgia (p<0.001). The scores of two groups were significant differencesafter the treatments．2、Complications of the treatment with botulinum toxin: three patients had transientnumbness of the mouth askew and incomplete eyelid closure. They got spontaneousrecovery after4to6weeks. Complications of microvascular decompression:3cases ofdizziness, one case of permanent hearing loss; one cases of partial facial numbness;1patient had compression cerebellar hemorrhage of the fourth ventricle due to the cerebellar hemorrhage. The patient received the second surgery for hematoma dissection and gotrecovery with facial numbness. No patients died during the treatment.3、Patients who were subjected to the surgery of microvascular decompression werefollowed up for6months to3years during which3patients had recurrence and therecurrence rate was15.0%. The alleviation of pain by botulinum toxin only persisted for6months after which re-injection of botulinum toxin was required to alleviate pain.Conclusions：1、BTX-A is safe and effective in the treatment of idiopathic trigeminalneuralgia. However, the effects of BTX sustained for shorter time compared with that ofMVD.2、Microvascular decompression (MVD) is more effective in the treatment ofidiopathic trigeminal neuralgia by comparison with Botulinum toxin type A (BTX-A),especially for the relief of pain. However, the MVD has more complications and higherrecurrence rate than BTX-A.3、 For the patients with idiopathic trigeminal neuralgia who are resistant toconventional drug therapy, have surgical contraindications or recurrence after surgery orare afraid of surgery, especially high age, surgical risk big patients,injection of botulinumtoxin type A is an alternative treatment.更多还原