摘要
目的探讨CT引导下经皮三叉神经半月节射频热凝术(PRT)治疗其他术式术后复发三叉神经痛的临床疗效及安全性。方法选取2002—2013年首都医科大学宣武医院疼痛科收治的采用CT引导下PRT治疗其他术式术后复发三叉神经痛的88例患者的临床资料。采用巴罗神经学研究所(BNI)分级评定标准评定患者临床疗效(疼痛缓解、疼痛未缓解)。记录患者术后并发症:面部麻木、咀嚼力下降、角膜炎、复视、脑脊液漏、死亡等。采用生存分析中的Kaplan-Meier法计算患者术后1、2、5、10年疼痛缓解率。结果本组88例患者均成功行CT引导下PRT。83例(94.3%)患者术后疼痛缓解,5例(5.7%)患者术后疼痛未缓解。88例患者术后1年疼痛缓解率为83.0%,术后2年疼痛缓解率为75.0%,术后5年疼痛缓解率为59.0%,术后10年疼痛缓解率为49.0%。76例(93.8%)患者在随访期间存在持续麻木;咀嚼肌力下降8例(9.1%);角膜炎4例(4.5%),其中三叉神经第一支受累1例、三叉神经三支均受累3例,采用人工泪液滴眼后症状缓解;无复视、脑脊液漏等严重并发症发生;无因CT引导下PRT死亡患者。结论 CT引导下PRT治疗其他术式术后复发三叉神经痛安全、有效,值得临床借鉴。
Objective To investigate the efficacy and safety of CT guided percutaneous radiofrequency thermocoagulation（PRT）in the treatment of recurrent trigeminal neuralgia after other surgical treatment. Methods From 2002 to 2013,we collected the clinical data of 88 patients with recurrent trigeminal neuralgia after other surgical treatment who were treated through CT guided PRT in Department of Pain Management,Xuanwu Hospital Capital Medical University. The clinical efficacy（pain remission and no pain remission）was evaluated using the grading scale of Barrow Neurological Institute（BNI）. Postoperative complications were recorded,including facial numbness,decrease in masticatory force, keratitis, diplopia, leakage of cerebrospinal fluid,death,etc. Kaplan - Meier method in survival analysis was conducted to calculate the pain relief rates in 1 year,2 years,5 years and 10 years after surgery. Results CT guided PRT was undertaken successfully on the 88 patients. There were 83（94. 3% ）who experienced immediate pain relief after surgery and 5 patients（5. 7% ）who had no pain relief after surgery. The pain relief rates in 1 year,2 years,5 years and 10 years after surgery were 83. 0% ,75. 0% ,59. 0%and 49. 0% respectively. There were 76（93. 8% ）patients who had continuous facial numbness in the follow - up period and 8 （9. 1% ）patients who had decrease in masticatory force. Four（4. 5% ）patients had keratitis,including one patient with the first branch of the trigeminal nerve involved and 3 patients with the third branch of the trigeminal nerve involved,and they had remission after using eye drops of artificial tears. No patients had diplopia,leakage of cerebrospinal fluid and other severe complications. No patients died due to CT guided PRT. Conclusion CT guided PRT is safe and effective in the treatment of recurrent trigeminal neuralgia after other surgical treatment and is worth being applied in clinical practice.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第12期1383-1386,共4页
Chinese General Practice
基金
北京市医院管理局临床医学发展专项经费资助项目(ZYLX201507)
关键词
三叉神经痛
经皮三叉神经射频热凝术
治疗结果
手术后并发症
Trigeminal neuralgia
Percutaneoustrigeminal radiofrequency thermocoagulation
Treatment outcome
Postoperative complications
