摘要：

目的 探讨微血管减压术治疗原发性三叉神经痛的有效性和安全性，并筛查其复发相关危险因素。方法 共 286 例单纯行微血管减压术的原发性三叉神经痛患者，分别于术前、术后和随访期间采用 Barrow 神经病学研究所（BNI）三叉神经痛分级评价疼痛缓解；记录术后并发症，包括术侧面部麻木感、术侧听力下降、脑脊液漏、手术切口愈合欠佳、颅内感染、脑积水；记录随访期间复发情况。单因素和多因素前进法 Logistic 回归分析筛查三叉神经痛复发相关危险因素。结果 286 例患者中术后 18 例（6.29%）出现术侧面部轻度麻木感，13 例（4.55%）术侧听力下降，1 例（0.35%）脑脊液漏，1 例（0.35%）手术切口愈合欠佳，2 例（0.70%）颅内感染，1 例（0.35%）脑积水。随访期间 26 例（9.09%）失访，13 例（4.55%）术后疼痛无缓解，13 例（4.55%）术后疼痛部分缓解，234 例（81.82%）术后疼痛完全缓解。234 例术后疼痛完全缓解患者平均随访31.29 个月，1例（0.35%）死于心脏病，28例（9.79%）复发。Kaplan-Meier曲线显示，术后疼痛完全缓解率随着随访时间的延长而逐渐下降，其中术后 1 年复发率 5.4%、术后 3 年15.2%、术后 5 年 21.2%。单因素和多因素前进法 Logistic 回归分析显示，术前 BNI 分级Ⅴ级是三叉神经痛复发的独立危险因素（OR = 2.385，95%CI：1.063 ~ 5.353；P = 0.035）。结论 微血管减压术治疗三叉神经痛安全、有效，无死亡或神经功能障碍等严重并发症。

关键词: 三叉神经痛, 显微外科手术, 复发, 危险因素, 回归分析

Abstract:

Objective  To analyze the efficacy and safety of pure microvascular decompression (MVD) for trigeminal neuralgia (TN), and to screen related risk factors for TN recurrence.  Methods  A total of 286 primary TN patients underwent pure MVD. Barrow Neurological Institute (BNI) grade was used to evaluate the relief of TN before and after surgery and during the follow-up. Postoperative complications were recorded, including facial numbness of operation side, hearing loss of operation side, cerebrospinal fluid (CSF) leakage, poor wound healing, intracranial infection and hydrocephalus. The recurrence during follow-up was also recorded. Univariate and multivariate forward Logistic regression analysis were used to screen related risk factors of recurrent TN.  Results  Of all patients, 18 cases (6.29%) had slight facial numbness of operation side after surgery, 13 cases (4.55% ) had hearing loss of operation side after operation. One (0.35%) had CSF leakage, and was cured after lumbar cistern drainage. One (0.35%) had no wound healing, and was cured after bone wax and repairing titanium mesh were removed in the reoperation. Two cases (0.70% ) had intracranial infection and were cured by antibiotic therapy. One (0.35%) had hydrocephalus and was cured after external ventricular drainage. Of 286 patients, 26 cases (9.09%) were lost during the follow-up, 13 cases (4.55%) had no pain relief after surgery, 13 cases (4.55%) had partial pain relief after surgery and 234 cases (81.82%) had complete pain relief after surgery. The follow-up period of 234 cases was a mean of 31.29 months. During follow-up, one case (0.35%) died of heart disease, and 28 cases (9.79%) had pain recurrence. Kaplan-Meier curve showed the rate of complete pain relief was decreased with time, the recurrence rate was 5.4% one year after surgery, 15.2% 3 years after surgery, and 21.2% 5 years after surgery. Univariate and multivariate forward Logistic regression analysis showed preoperative BNI grade Ⅴ was independent risk factor for recurrence of TN (OR = 2.385, 95%CI: 1.063-5.353; P = 0.035).  Conclusions  Pure MVD for treating TN is safe and effective, without postoperative death or severe complications.

Key words: Trigeminal neuralgia, Microsurgery, Recurrence, Risk factors, Regression analysis