某教学医院两种手术方法治疗原发性三叉神经痛的临床对比研究

发布时间：2018-01-24 07:54

本文关键词： 神经内镜显微镜三叉神经痛微血管减压术　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景三叉神经痛是一种国内外常见疾病,其临床表现特点为面部有三叉神经分布的区域出现反复短暂性、发作性、电击样剧烈疼痛,使病人的身心健康受到严重危害。目前在临床上,三叉神经痛通常被分为原发性和继发性两个大类别。原发性三叉神经痛的治疗方法包括封闭疗法、射频热凝、药物治疗、三叉神经微血管减压手术等多种不同方式,其中三叉神经微血管减压术为当前治疗原发性三叉神经痛的被临床工作者普遍接受的首选手术方法。三叉神经痛微血管减压手术最初的施行是在传统显微镜下进行手术,近年来,随着神经内镜技术的不断发展,神经内镜在神经外科手术领域的应用不断拓展,单纯神经镜下原发性三叉神经痛微血管减压术的开展因其微创、视野清晰等诸多方面的优势而逐渐成为主流。研究目的目前,神经内镜技术已经成为微创神经外科的重要组成部分,随着设备的改进与手术技术的发展进步,其应用领域逐渐扩大。本研究对比分析单纯神经内镜下微血管减压术与传统显微镜下微血管减压术治疗原发性三叉神经痛的有关资料,探讨和评价单纯神经内镜在三叉神经痛治疗应用中的安全性和优越性,为三叉神经痛治疗实践中对不同手术方式进行选择提供可靠临床依据。资料与方法对山东大学齐鲁医院神经外科2013年12月至2016年12月期间,收治的162例原发性三叉神经痛患者治疗的临床资料和术后随访结果(其中67例行单纯神经内镜下微血管减压术,95例行传统显微镜下微血管减压术)进行回顾性分析。分析比较单独采用神经内镜手术与传统显微镜下手术的相关指标。对手术切口及术中所见视野显露情况进行比较,对患者的一般资料、手术平均时间、术中平均出血量、术后平均住院时间的差异;术后疼痛缓解情况;术中其他中枢神经损伤情况,出现面部麻木、面瘫、听力减退、脑脊液漏、感染等并发症的发生情况及疼痛复发情况等分别进行统计对比分析,并对疼痛复发情况做Kaplan-Meier分析。研究中计量资料的比较采取t检验的方法,计数资料的比较采取卡方检验的方法,防止复发函数做Kaplan-Meier分析,检验水准以P0.05认为有统计学差异。主要结果本研究纳入研究的171例原发性三叉神经痛患者中,实际随访到了 162人,随访率94.74%。随访到的患者中行单纯神经内镜手术的有67人,行传统显微镜下手术的有95人。单纯神经内镜组65人完全缓解,2人部分缓解,手术完全缓解率97.01%;手术时间70～100min,平均85.31min;术中出血量20～40ml,平均30.70ml;术后住院时间5～8d,平均6.209d;术后2例患者出现患侧麻木,经治疗后好转,术后并发症发生率2.99%;术后3人复发,复发率4.48%。传统显微镜组83人完全缓解,12人部分缓解,手术完全缓解率87.37%;手术时间85～120min,平均102.6min;术中出血量50～150ml,平均104.7ml;术后住院时间6～11d,平均8.649d;术后6例患者出现面部麻木,5例患者有舌面部麻木,2例患者出现耳鸣,1例患者述头晕,均经治疗后好转,并发症发生率14.74%;术后14人复发,复发率14.74%。随访期间无死亡病例。神经内镜组与显微镜组均能有效缓解症状,但神经内镜相对更佳(P=0.0314),而神经内镜组在平均手术时间(P0.0001)、术中出血量(P0.0001)、术后住院时间(P0.0001)、并发症发生率(P=0.0135)以及术后疼痛复发率(P=0.0359)等方面显著优于显微镜组,差异有统计学意义。结论与建议单纯神经内镜下微血管减压术与传统显微镜下微血管减压术治疗原发性三叉神经痛均有良好效果,手术疗效满意,安全性高,但单纯神经内镜下微血管减压术在平均手术时间、术中出血量、术后住院时间、并发症发生情况等方面更优于显微镜下手术,单纯神经内镜下微血管减压术是治疗原发性三叉神经痛的较佳选择,有向临床进一步推广的意义。与此同时,单纯神经内镜的手术应用对手术操作者的技巧与经验有较高要求,应进一步加强单纯神经内镜下原发性三叉神经痛微血管减压手术的拓展学习与培训。
[Abstract]:The research background of trigeminal neuralgia is a common disease at home and abroad, its clinical features for facial trigeminal nerve distribution area of recurrent transient episodes of severe pain, shock like, make the patient's physical and mental health seriously. At present in the clinic, the trigeminal nerve pain is usually divided into primary and the secondary two categories. Treatment of primary trigeminal neuralgia including closed therapy, radiofrequency ablation, drug therapy, microvascular decompression for trigeminal neuralgia and so many different ways, including microvascular decompression of the trigeminal nerve for the treatment of primary trigeminal neuralgia is accepted by clinical workers preferred surgical method. The implementation of microvascular decompression for trigeminal neuralgia was originally operated in the traditional microscope in recent years, with the development of endoscopic technology, endoscopic surgical field in the Department of Neurosurgery The applications continue to expand, to carry out a simple neural endoscopic primary microvascular decompression for trigeminal neuralgia due to its minimally invasive, clear vision etc. many advantages and has gradually become the mainstream. The purpose of the current study, endoscopic technology has become an important part of minimally invasive Department of Neurosurgery, along with the development and improvement of surgical technique equipment. Its application gradually expanded. In this study, a comparative analysis of the relevant data of endoscopic microvascular decompression under microscope and traditional microvascular decompression in the treatment of primary trigeminal neuralgia, investigate and evaluate the single pure endoscopic application in the treatment of trigeminal neuralgia in the safety and superiority, to provide reliable basis for clinical selection different surgical methods in the treatment of trigeminal neuralgia in practice. During the period of December 2013 to December 2016 in the Department of Neurosurgery of Qilu Hospital of Shandong University, received Treatment of 162 cases of clinical data and surgical treatment of primary trigeminal neuralgia patients after follow-up results (including 67 cases underwent endoscopic microvascular decompression, 95 cases underwent traditional microscope microvascular decompression) were retrospectively analyzed. Analyzed and compared separately using related indexes of endoscopic surgery and traditional surgery under microscope. Compared in the visual field of surgical incision and surgical findings, the general data of patients, the average operation time, average bleeding volume, average hospitalization time after the operation of the difference; relief of postoperative pain; intraoperative other central nerve injury, appear facial numbness, facial paralysis, hearing loss, cerebrospinal fluid leakage, infection etc. The incidence of complications and pain recurrence were statistically analyzed, and the pain recurrence Kaplan-Meier analysis. Compared to the measurement data of t test. Method, compared by the chi square test count data, prevent the recurrence of Kaplan-Meier function analysis, standard test to P0.05 that there was statistically significant difference. The main results of the 171 patients included in the study of primary trigeminal neuralgia patients, the follow-up to 162, follow-up rate of 94.74%. follow-up to patients received simple nerve endoscopic surgery has 67 people, for the traditional microscope operation in 95 cases. Endoscopic group 65 complete remission, 2 partial remission, complete surgical remission rate was 97.01%; the average operation time was 70 ~ 100min, 20 ~ 85.31min; output 40ml, the average intraoperative 30.70ml; postoperative hospitalization time was 5 ~ 8D on average, 6.209d; after 2 patients had ipsilateral numbness, improved after treatment, the postoperative complication rate was 2.99%; 3 recurrence after operation, the recurrence rate of 4.48%. group 83 traditional microscope complete remission, 12 partial remission, complete surgical remission rate was 87. 37%; operation time was 85 ~ 120min, average 102.6min; intraoperative blood loss was 50 ~ 150ml, average 104.7ml; postoperative hospitalization time was 6 ~ 11d, average 8.649d; after 6 cases of patients with facial numbness, 5 cases of patients with lingual facial numbness, 2 cases of patients with tinnitus, 1 patients were treated by the dizziness. Improved after treatment, the complication rate was 14.74%; 14 recurrence after operation, there were no deaths during follow-up. The recurrence rate of 14.74%. group and endoscopic microscope group can effectively alleviate the symptoms, but relatively better endoscopic (P=0.0314), and endoscopic group in the mean operative time (P0.0001), bleeding (P0.0001) the hospitalization time, postoperative complication rate (P0.0001), (P=0.0135) and postoperative pain recurrence rate (P=0.0359) were significantly superior to microscopy group, the difference was statistically significant. Conclusions and suggestions of endoscopic microvascular decompression with traditional microvascular decompression under microscope The surgical treatment of primary trigeminal neuralgia surgery had a good effect, satisfactory curative effect, high safety, but the simple endoscopic microvascular decompression in the average operation time, bleeding volume, postoperative hospitalization time, complications more than microscopic surgery, endoscopic microvascular decompression is better treatment of primary trigeminal neuralgia, further promotion to the clinical significance. At the same time, the simple operation of endoscopic surgery on the operator's skill and experience have higher requirements, should be expanded to further strengthen the learning and training of primary endoscopic microvascular decompression for trigeminal neuralgia.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.3

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