3种微创疗法在复发性三叉神经痛中的临床应用

Clinical application of three minimally invasive therapies in recurrent trigeminal neuralgia

摘要:

目的 探讨3种微创疗法在复发性三叉神经痛（TN）中的临床应用效果。方法 回顾性分析2016年7月—2020年7月在井冈山大学附属医院就诊的99例复发性TN患者的病例资料，根据微创疗法不同分为A组（32例）、B组（36例）、C组（31例）。A组接受经皮射频热凝术治疗，B组接受显微血管减压术（MVD）治疗，C组接受经皮穿刺微球囊压迫术（PBC）治疗。对比3组围手术期相关指标、术后缓解程度、负性情绪、睡眠质量及并发症，随访2年，对比3组复发率。结果 B组术中出血量多于A组、C组（P <0.05），C组术中出血量多于A组（P <0.05）；B组术后住院时间、手术时间长于A组、C组（P <0.05），C组术后住院时间、手术时间长于A组（P <0.05）。3组术后1 d、术后1年总缓解率比较，差异无统计学意义（P >0.05），B组、C组术后2年总缓解率高于A组（P <0.05）。A组、B组、C组术前、术后1 d、术后7 d、术后6个月的综合医院焦虑抑郁量表（HADS）焦虑部分评分、HADS抑郁部分评分、匹兹堡睡眠质量指数（PSQI）评分比较，结果 ①不同时间点HADS焦虑部分评分、HADS抑郁部分评分、PSQI评分比较，差异均有统计学意义（P <0.05）；②A组、B组、C组HADS焦虑部分评分、HADS抑郁部分评分、PSQI评分比较，差异均有统计学意义（P <0.05）；③3组HADS焦虑部分评分、HADS抑郁部分评分、PSQI评分变化趋势比较，差异均有统计学意义（P <0.05）。3组患者口周疱疹、面部麻木、咀嚼肌无力、脑脊液漏、局部血肿发生率比较，差异均无统计学意义（P >0.05）。A组复发率高于B组、C组（P <0.05）。结论 相比于经皮射频热凝术、MVD、PBC更有助于减轻患者负性情绪，提高患者睡眠质量，减轻疼痛，且复发风险较低。

Abstract:

Objective To investigate the clinical efficacy of three minimally invasive therapies in recurrent trigeminal neuralgia (TN).Methods Clinical data of 99 patients with recurrent TN treated in our hospital from July 2016 to July 2020 were retrospectively analyzed. The patients were divided into group A (32 cases), group B (36 cases) and group C (31 cases) according to the minimally invasive therapy applied. Specifically, group A received percutaneous radiofrequency thermocoagulation, group B received microvascular decompression (MVD), and group C received percutaneous microballoon compression (PBC). Perioperative indicators, postoperative remission, negative emotions, sleep quality and complications were compared among the three groups. The recurrence rate of the three groups was compared after 2 years of follow-up.Results The intraoperative blood loss in group B was higher than that in group A and group C (P < 0.05), and that in group C was even higher compared with group A (P < 0.05). The length of postoperative hospital stay and operative duration in group B were longer than those in group A and group C (P < 0.05), and those in group C were even longer than those in group A (P < 0.05). The overall remission rates 1 d and 1 year after surgery were not different among the three groups (P > 0.05), whereas the overall remission rate 2 years after surgery in group C and group B was higher than that in group A (P < 0.05). The subscale scores for anxiety and depression in Hospital Anxiety and Depression Scale (HADS) and Pittsburgh Sleep Quality Index (PSQI) scores in the three groups before and 1 day, 7 days and 6 months after surgery were compared via repeated measures analysis of variance. The results revealed that there were differences in subscale scores for anxiety and depression in HADS and PSQI scores among the time points (P < 0.05) and the groups, and that the change trends of these scores were also different among the groups (P < 0.05). There was no significant difference in the incidence of perioral herpes, facial numbness, masticatory muscle weakness, cerebrospinal fluid leakage and local hematoma among the three groups (P > 0.05). The recurrence rate of group A was higher than that of group B and group C (P < 0.05).Conclusions Compared with percutaneous radiofrequency thermocoagulation and MVD, PBC is more conducive to alleviating negative emotions, improving sleep quality, ameliorating the pain, and lowering the risk of recurrence for patients with recurrent TN.