经翼腭窝与经卵圆孔射频热凝术治疗原发性三叉神经上颌支疼痛的临床比较

摘要

Objective:To compare the effectiveness of radiofrequency thermocoagulation treatment via pterygopalatine fossa and via foramen ovale in patients with idiopathic trigeminal neuralgia (maxillary nerve).Methods:From January 2008 to Jtme 2010,90 patients with intractable idiopathic trigeminal neuralgia (maxillary nerve) were enrolled and randomly divided into two groups.Under the guidance of digital subtraction angiography (DSA),group A were treated with radiofrequency thermocoagulation via pterygopalatine fossa while group B underwent radiofrequency thermocoagulation via foramen ovale.After the operation,the efficacy including VAS,recurrence rate,side effects and complications of the surgery from both groups were recorded till the 24th month and analyzed for comparison.Results:Both groups showed significant decrease of visual analogue scale (VAS) after the operation (P ＜ 0.05).There were no significant differences between the two groups in terms of clinical effects and recurrence rate (P ＞ 0.05),but group A had less complications compared to group B (P ＜ 0.05).Conclusion:Radiofrequency thermocoagulation treatment of maxillary nerve via pterygopalatine fossa and via foramen ovale has a good long term effect.Compared to operation via foramen ovale,the pterygopalatine fossa has less complications.%目的:对经翼腭窝与经卵圆孔射频热凝术治疗原发性三叉神经上颌支顽固性疼痛进行疗效比较.方法:2008年1月～2010年6月,90例原发性三叉神经上颌支顽固性疼痛患者被纳入；随机分成A组和B组,每组45例；A、B两组在数字减影血管造影(digital subtraction angiography,DSA)引导下分别进行经翼腭窝或经卵圆孔三叉神经上颌支射频热凝治疗；随访24个月,观察术前与术后不同时段的视觉模拟评分(visual analogue scale,VAS),同时记录术后不良反应、并发症及复发率,进行统计比较.结果:术后两组VAS评分均显著下降(P＜0.05)；术后疗效及复发率组间比较,差异无统计学意义(P＞0.05),但B组的术后并发症发生率显著高于A组(P＜0.05)；结论:DSA下经翼腭窝与经卵圆孔三叉神经上颌支射频热凝术相比,两者均有确切的临床疗效；两种治疗方法的近、中期疗效相当,但前者的术后并发症少于后者.