后组脑神经间隙入路在显微血管减压术治疗椎-基底动脉扩张延长症合并面肌痉挛中的应用

发布时间：2018-03-21 14:05

本文选题：面肌痉挛　切入点：微血管减压术　出处：《南京医科大学学报(自然科学版)》2017年06期 　论文类型：期刊论文

【摘要】：目的:探讨通过后组神经间隙入路显微血管减压术(microvascular decompression,MVD)治疗椎-基底动脉扩张延长症(vertebrobasilar dolichoectasia,VBD)相关性面肌痉挛患者的疗效及并发症情况。方法:回顾性分析2014年7月—2016年7月南京医科大学附属杭州医院治疗的166例面肌痉挛患者,按照Ubogu和Zaidat的标准,42例患者符合VBD诊断标准,为VBD组,其余124例患者为常规组,手术方法及术者无差异。结果:VBD组与常规组在年龄及性别方面无明显差异(P0.05)。VBD组整体治愈率90.5%,术后并发症包括手术同侧迟发面瘫1例,听力下降1例,术后延迟缓解率11.9%。常规组整体治愈率92.7%,术后并发症包括手术同侧面瘫2例,听力下降3例,耳鸣2例,饮水呛咳1例,无菌性脑膜炎1例,术后延迟缓解率1.61%。两组在治愈率方面疗效相似(P=0.638);并发症发生率差异无统计学意义(P=0.575);但VBD组延迟缓解率较常规组高,差异有统计学意义(P=0.04)。结论:VBD导致桥小脑角空间狭小,使得手术难度显著增加。MVD从后组颅神经间隙进入进行架桥式操作,可以降低椎动脉对面神经的张力,进而抬起椎动脉,寻找真正责任血管,有效避免小血管的遗漏和分支的损伤。术后并发症及手术效果与常规组相仿。VBD合并面肌痉挛患者术后有一定的延迟缓解率。
[Abstract]:Objective: to investigate the efficacy and complications of microvascular decompression via posterior nerve gap approach in the treatment of vertebrobasilar dilatation and extension of vertebrobasilar artery (vertebrobasilar dolichoectasia) associated with hemifacial spasm. Methods: July 2014. In July 2016, 166 patients with hemifacial spasm treated by Hangzhou Hospital affiliated to Nanjing Medical University, According to the criteria of Ubogu and Zaidat, 42 cases were in accordance with the diagnostic criteria of VBD, the other 124 cases were routine group. Results there was no significant difference in age and sex between the two groups in terms of age and sex. The overall cure rate of the VBD group was 90.5%. Postoperative complications included delayed facial palsy in 1 case and hearing loss in 1 case. The total cure rate of routine group was 92.7%. Postoperative complications included surgical ipsilateral facial paralysis in 2 cases, hearing loss in 3 cases, tinnitus in 2 cases, cough in drinking water in 1 case, aseptic meningitis in 1 case. The postoperative delayed remission rate was 1.61.The curative effect of the two groups was similar to that of P0.6380.There was no significant difference in the incidence of complications between the two groups, but the delayed remission rate in the VBD group was higher than that in the conventional group, and the difference was statistically significant. Conclusion the space of cerebellopontine angle is small due to the small space of cerebellopontine angle in VBD group. The difficulty of the operation is significantly increased. MVD can be used to bridge the cranial nerve space in the posterior group, which can reduce the tension of the vertebral artery to the facial nerve, and then lift up the vertebral artery to look for the truly responsible blood vessel. The postoperative complications and surgical results were similar to those in the routine group. There was a delayed remission rate in patients with hemifacial spasm.
【作者单位】：南京医科大学附属杭州医院神经外科;
【分类号】：R651.3

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