微血管减压术治疗面肌痉挛的疗效与责任血管类型的关系分析

发布时间：2018-03-25 20:14

本文选题：微血管减压术　切入点：面肌痉挛　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:评价微血管减压术治疗面肌痉挛的疗效,分析责任血管类型与微血管减压术疗效的关系。方法:回顾性分析2014年3月-2015年12月期间,河北医科大学第二医院神经外科住院,接受微血管减压术治疗的80例原发性面肌痉挛病人,入院后均行颅脑MRI平扫以及3D-TOF-MRA成像和3D-FIESTA序列检查,除外继发性病因,行微血管减压术,术中显露面神经出脑干区,根据影像学资料与手术所见,探明责任血管,按照其类型不同分成两组:椎-基底动脉压迫组(责任血管含有椎-基底动脉)17例;小血管压迫组(责任血管不含椎-基底动脉)63例。松解压迫面神经的责任血管,在责任血管与脑干间置入适量的Teflon垫片,观察及跟踪病人的疗效与并发症情况,进行统计学分析。结果:观察并随访12-30个月,治愈46例(57.50%),改善25例(31.25%),无效9例(11.25%),有效(治愈与改善)71例,总有效率为88.75%,椎-基底动脉压迫组有效12例(70.60%),小血管压迫组有效59例(93.70%),椎-基底动脉压迫组疗效较小血管压迫组差,两组疗效差异有统计学意义(P=0.008)。出现延迟治愈23例(28.75%),椎-基底动脉压迫组8例(47.06%),小血管压迫组15例(23.81%),椎-基底动脉压迫组延迟治愈发生率较小血管压迫组高,两组延迟治愈发生率无统计学意义(P=0.060)。出现复发3例(3.75%),其中椎-基底动脉压迫组1例,小血管压迫组2例。并发症主要为听力下降出现8例,迟发型面瘫出现4例。Logistic回归分析:变量责任血管类型P值为0.027,OR值为5.867,95%CI:1.228-28.018。责任血管包含椎-基底动脉是手术疗效差的独立危险因素。结论:微血管减压术目前治疗原发性面肌痉挛的有效率高,复发、无效及并发症发生率较低。责任血管含有椎-基底动脉的面肌痉挛患者微血管减压术疗效较差。
[Abstract]:Objective: to evaluate the efficacy of microvascular decompression in the treatment of hemifacial spasm, and to analyze the relationship between the type of responsible vessels and the efficacy of microvascular decompression. 80 cases of primary hemifacial spasm treated by microvascular decompression were treated by neurosurgery, the second Hospital of Hebei Medical University. After admission, all patients underwent MRI plain scan, 3D-TOF-MRA imaging and 3D-FIESTA sequence examination, except for secondary etiology. After microvascular decompression, the facial nerve came out of the brainstem area during the operation. According to the imaging data and the operative findings, the responsible vessels were identified and divided into two groups according to their different types: vertebrobasilar artery compression group (17 cases of the responsible vessels containing vertebrobasilar artery); In the small vessel compression group (63 cases of the responsible vessel without vertebrobasilar artery), the responsible vessel of the facial nerve was released and the appropriate amount of Teflon gasket was placed between the responsible vessel and the brainstem to observe and follow up the curative effect and complications of the patient. Results: after observation and follow-up for 12-30 months, 46 cases were cured (57.50), 25 cases improved (31.25%), 9 cases were ineffective (11. 25%), 71 cases were cured and improved. The total effective rate was 88.75. 12 cases were effective in vertebrobasilar artery compression group, 59 cases were effective in small vessel compression group. The effect of vertebrobasilar artery compression group was worse than that of small vessel compression group. The difference between the two groups was statistically significant. There were 23 cases of delayed cure, 8 cases of vertebrobasilar artery compression group (n = 8) and 15 cases of small vessel compression group (n = 15). The incidence of delayed cure in vertebrobasilar artery compression group was higher than that in small vessel compression group. There was no significant difference in the incidence of delayed cure between the two groups. There were 3 cases of recurrence (1 case in vertebrobasilar artery compression group and 2 cases in small vessel compression group). The main complication was hearing loss in 8 cases. Logistic regression analysis of 4 cases with delayed facial palsy: variable responsible vessel type P = 0.027 OR = 5.867% 95 CI: 1.228-28.018.The responsible vessel contains vertebrobasilar artery is an independent risk factor for poor surgical efficacy. Conclusion: microvascular decompression is an independent risk factor for the current treatment of microvascular decompression. The effective rate of hemifacial spasm is high, The incidence of recurrence, ineffectiveness and complications was low. Microvascular decompression was poor in patients with facial spasm with vertebrobasilar artery.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.3

【参考文献】