微血管减压术与经皮穿刺球囊压迫治疗复发三叉神经痛的疗效比较

摘要

Objective To compare the effect of microvascular decompression(MVD)versus percutaneous balloon compression(PBC)for recurrent trigeminal neuralgia after MVD.Methods The clinical data of 92 patients o with recurrent trigeminal neuralgia after MVD,in whom 25 were treated by MVD(MVD group),and 67 by PBC(PBC group)from January 2009 to January 2016, were analyzed retrospectively.The therapeutic efficacy, operation time, inpatient time and complications were compared between two groups.Results There were no significant differences in overall effective rate between two groups(96.0%vs.94.0%,P>0.05).However,the curative rate in MVD group was higher than that in PBC group(88.0% vs.64.2%,P<0.05).The recurrence rate was higher in PBC group than in MVD group(27.0%vs.4.2%,P<0.05).The operation time and hospital stay in MVD group was longer than that in PBC group[(102.0 ±28.2)min vs.(20.9 ±10.6)min,(11.7 ±3.5)d vs.(4.3 ±1.8)d,all P <0.05).The incidence of trigeminal depressor response and facial numbness was significantly greater in PBC group than MVD group (26.9%vs.4.0%,92.5% vs.16.0%,all P <0.05).There was no significant differences of herpetic stomatitis in both groups(32.0 % vs.40.3%,P >0.05).37 patients had masseter weakness in PBC group.One patient had surgical incision infection and one patient had tinnitus in MVD group.Conclusions MVD and PBC both are effective in treatment of recurrent trigeminal neuralgia after MVD.The MVD is higher cure rate,lower pain recurrence rate and lower incidence of trigeminal depressor response,facial numbness and masseter weakness.The PBC has the higher security,minimal injury,shorter operation time and inpatient time.%目的 探讨微血管减压术(MVD)与经皮穿刺球囊压迫(PBC)治疗MVD术后复发三叉神经痛的临床疗效.方法 回顾性分析2009年1月至2016年1月分别采用MVD(25例,MVD组)与PBC(67例, PBC组)治疗的MVD术后复发三叉神经痛患者的临床资料,比较两组患者的手术疗效、手术时间、住院时间及并发症.结果 MVD组和PBC组的有效率分别为96.0%和94.0%,两组比较差异无统计学意义(P>0.05);MVD组治愈率高于PBC 组(88.0% vs 64.2%,P<0.05);PBC 组复发率高于MVD组(27.0% vs 4.2%,P<0.05);MVD组手术时间及住院时间长于PBC组[(102.0 ±28.2)min vs(20.9 ±10.6)min,(11.7 ±3.5)d vs(4.3 ±1.8)d,均P<0.05);PBC组三叉神经抑制反应、面部麻木发生率高于MVD组(26.9% vs 4.0%,92.5%vs 16.0%,均P<0.05);MVD组与PBC组口角疱疹发生率比较差异无统计学意义(32.0 % vs 40.3%,P>0.05).PBC组出现咀嚼肌乏力37例;MVD组发生切口感染1例,术侧耳鸣1例.结论 MVD和PBC均能有效治疗MVD术后复发三叉神经痛.MVD的治愈率高,复发率低,三叉神经抑制反应、面部麻木、咀嚼肌乏力等并发症少;而PBC具有安全性高、创伤小、手术时间及住院时间短的优点.