三叉神经射频热凝术在CT三维成像与C臂引导下的疗效与安全性比较

发布时间：2018-03-01 19:21

  本文关键词： CT三维重建 C型臂 卵圆孔 疗效 并发症　出处：《承德医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探究三叉神经射频热凝术在CT三维重建后Hartel穿刺路径角度下与在C型臂引导下的临床疗效、术中穿刺情况及并发症。通过比较两种不同引导方式的手术临床疗效及安全性,从而找到更合适的手术引导方式并建立卵圆孔外口在Hartel穿刺路径下的数据。方法:选取2015年3月至2016年3月就诊于首都医科大学宣武医院疼痛科的40例原发性三叉神经痛患者,患者术前行头颅核磁共振(MRI)检查排除占位性病变。告知相关风险后,患者自愿行介入治疗并签属手术同意书。采用入院顺序单双号将患者分为A、B两组,每组各20名患者。A组、B组患者分别在CT三维重建、C型臂引导下行三叉神经射频热凝术。入室后患者取卧位,连接监护仪给予心率(HR)、血氧饱和度(SPO2)、收缩压(SBP)及舒张压(DBP)连续监测,建立静脉输液通路,给予阿托品0.5mg。A组患者进行CT头颅扫描并三维重建,旋转重建后颅骨,通过Hartel穿刺路径测量卵圆孔外口长短径及观察有无其他穿刺影响因素后设计穿刺路径。而B组用C型臂放射卵圆孔,观察卵圆孔位置,设计穿刺路径。局部皮肤消毒,铺无菌单。用1%利多卡因于下颌角3cm局麻,22G射频针自下颌角外侧3cm穿刺至同侧卵圆孔。分别用CT三维重建、C型臂确定射频针尖位于卵圆孔处,行感觉运动测试成功复制疼痛后,行连续射频70℃,120s,2次。拔除射频针,穿刺点贴无菌敷贴。术毕观察30min,送回病房。两组患者均于术前(T0)时、出院时(T1)及术后1年(T2)时对患者进行视觉模拟评分(VAS)测量,比较两组患者术前VAS差异及术后临床疗效。统计术中穿刺数及术后并发症情况。建立卵圆孔外口在Hartel穿刺路径下的数据。结果:1、两组患者术前视觉模拟评分(VAS)比较A组患者术前VAS评分为8.85±1.04分,B组患者术前VAS评分为8.65±1.04分,术前(T0)时两组VAS评分无明显统计学差异(P0.05)。2、两组患者术后出院(T1)时视觉模拟评分(VAS)比较A组患者术后出院时VAS评分为1.05±0.69分,B组患者术后出院时VAS评分为1.05±0.83分,术后出院(T1)时两组VAS评分无明显统计学差异(P0.05)。3、两组患者术后1年(T2)时视觉模拟评分(VAS)比较A组患者术后术后1年(T2)时VAS评分为1.45±1.00分,B组患者术后1年(T2)时VAS评分为1.65±1.60分,术后1年(T2)时两组VAS评分无明显统计学差异(P0.05)。4、两组患者术中穿刺数比较A组患者术中第一针入孔率为90%,B组患者术中第一针入孔率为50%,A组患者第一针入孔率较B组患者第一针入孔率显著提高(P0.05)。5、两组患者术中穿刺时间的比较A组患者术中穿刺所需时间为25.8±17.27秒;B组患者术中穿刺所需时间为42.3±25.71秒;两组术中穿刺时间有明显统计学差异,A组的穿刺所需时间显著降低(P0.05)。6、两组患者并发症比较A组仅出现2例术后头痛。B组患者3例表现为术后头痛,3例表现为面部肿胀,2例表现为咀嚼无力,1例表现为术后眩晕、耳鸣。B组的并发症发生率45%明显高于A组并发症发病率10%(P0.05)。7、卵圆孔外口在Hartel穿刺路径下的数据A组患者重建后的颅骨经过旋转后在Hartel穿刺路径下最大限度暴露卵圆孔时,卵圆孔的长径为5.01±2.14mm,短径长度为3.1±2.10mm。结论:CT三维重建引导下行三叉神经射频热凝术(RFT)与在C型臂引导下行三叉神经射频热凝术治疗原发性三叉神经痛(classical trigeminal neuralgia,CTN)均可明显降低疼痛程度。CT三维重建引导下行三叉神经射频热凝术(RFT)在穿刺卵圆孔过程优于在C型臂引导下行三叉神经射频热凝术,可以明显降低并发症的发生率,更为安全。
[Abstract]:Objective: To explore the trigeminal nerve radiofrequency thermocoagulation for the clinical efficacy of Hartel guided puncture path and angle in the C arm in CT reconstruction after puncture and complications during surgery. Clinical efficacy and safety by comparing two different guiding modes, so as to find a more suitable surgical guidance and the establishment of the foramen ovale outside the mouth in the Hartel puncture path of the data. Methods: from March 2015 to March 2016 in Xuanwu Hospital of Capital Medical University, the Department of pain in 40 cases of primary trigeminal neuralgia patients, preoperative cranial magnetic resonance (MRI) examination to exclude lesions. Inform the relevant risk after interventional therapy for patients with voluntary and sign the consent form. The dual number of hospital patients were divided into A, B two groups, each group of 20 patients in.A group, B group of patients were in CT reconstruction, C arm guided radio frequency thermocoagulation of trigeminal nerve After entering the room. The patient supine, connect the monitor to the heart rate (HR), oxygen saturation (SPO2), systolic blood pressure (SBP) and diastolic blood pressure (DBP) continuous monitoring, the establishment of intravenous infusion pathway, 0.5mg.A group were given atropine CT scan and three-dimensional reconstruction, reconstruction of skull after rotation, through the puncture path design Hartel measurement of foramen ovale puncture path outside diameter and observe whether other factors influence. While group B puncture with C arm radiation foramen ovale, observe the location of foramen ovale, design of puncture path. Local skin disinfection, sterile. With 1% lidocaine in local anesthesia mandibular angle 3cm, 22G RF needle from the mandibular angle 3cm puncture to the ipsilateral lateral foramen ovale. Respectively using CT 3D reconstruction, C arm to determine the RF tip is positioned in the foramen ovale, feeling pain after exercise test successfully, continuous RF 70 DEG C, 120s, 2. Removal of RF needle puncture point with sterile dressing. Postoperative view 瀵，

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