显微血管减压术治疗原发性三叉神经痛疗效的相关因素

摘要

Objective To investigate the related factors affecting the efficacy of microvascular decompression (MVD) in the treatment of primary trigeminal neuralgia (TN). Methods MVD was performed in 120 patients with primary TN and single factor χ2 test and Logistic regression analysis were performed on the clinical data to evaluate the independent risk factors influencing the efficacy of MVD in the treatment of primary TN. Results The pain completely disappeared in 101 cases, the pain was relieved in 16 cases and the unhealed in 3 cases. Sixty cases had pure arterial compression,57 cases had venous compression, and 3 cases had no obvious responsibility vessel. Complete elimination of pain in the patients with venous compressionwaslower than that in patients with pure arterial oppression: 73.7% (42/57) vs. 86.7% (52/60), and the difference was statistically significant (P<0.05). The complete pain relief rate in patients with V2 bronchial pain was lower than that in other pain distribution areas: 13/19 vs. 87.1%(88/101), With significant difference (P<0.05). In patients with V2 bronchitis, the responsible vessels were mostly compressed from the ventral surface of the trigeminal nerve, and the difference was statistically significant (P<0.05). Logistic regression analysis showed , Venous compression and V2 pain were the independent risk factors influencing the clinical efficacy of MVD in the treatment of primary TN. Conclusions Patients with venous compression and V2 pain are less likely to havegood postoperative outcomes, and venous compression and V2 painare independent risk factors. In patients with V2 pain, the responsible vasculature tends to ventrally massage the trigeminal nerve, which is a new study direction of refractory V2 pain.%目的 探讨影响显微血管减压术(MVD)治疗原发性三叉神经痛(TN)疗效的相关因素.方法 对2008年1月至2018年12月河西学院附属张掖人民医院神经外科收治的120例原发性TN患者施行MVD手术治疗的临床资料进行单因素χ2检验及Logistic多因素回归分析,评价影响MVD治疗原发性TN疗效的独立危险因素.结果 疼痛完全消失101例,疼痛明显缓解16例,未愈3例;60例单纯受动脉压迫,57例合并静脉压迫,3例无明显责任血管,合并静脉压迫的患者术后疼痛完全消除率较单纯动脉压迫者低[73.7%(42/57)比86.7%(52/60)],且差异有统计学意义(P＜0.05);上颌支(V2)疼痛的患者术后疼痛完全消除率较其他疼痛分布区患者低[13/19比87.1%(88/101)],差异有统计学意义(P＜0.05),且V2疼痛的患者,责任血管多自三叉神经的腹侧压迫,且差异有统计学意义(P＜0.05);Logistic回归分析显示,静脉压迫和V2疼痛是影响MVD治疗原发性TN临床疗效的独立危险因素.结论 静脉压迫、V2疼痛的患者术后疗效较差,为独立危险因素,V2疼痛的患者,其责任血管多自三叉神经腹侧压迫三叉神经,这成为难治性V2疼痛新的研究方向.