摘要：

目的 对比微血管减压术与非手术治疗老年原发性三叉神经痛的有效性和安全性。方法 共 133 例 > 75 岁的老年原发性三叉神经痛患者分别行微血管减压术（MVD 组，80 例）和非手术治疗（非手术治疗组，53 例，包括脉冲射频术 38 例、立体定向伽马刀放射治疗 10 例、针灸治疗 5 例），McGill疼痛问卷（MPQ）评价疼痛缓解程度，世界卫生组织生活质量量表（WHOQoL-100）评价生活质量，并记录术后并发症，包括面部感觉迟钝、头痛、恶心呕吐、肺炎、颅内感染、脑脊液漏、深静脉血栓形成、不完全性面瘫、听力缺失、运动障碍等。结果 MVD 组患者 79 例（98.75%）疼痛完全缓解、1 例（1.25%）疼痛部分缓解，非手术治疗组 8 例（15.09%）疼痛完全缓解、33 例（62.26%）疼痛部分缓解、12例（22.64%）疼痛无缓解，组间差异有统计学意义（χ²= 84.241，P = 0.000）。随访55.80（35.74，63.48）个月，MVD 组复发率低于非手术治疗组［8.75%（7/80）对 35.85%（19/53）；χ²= 16.558，P = 0.000］，生活质量优于非手术治疗组［WHOQoL-100 评分（27.82 ± 2.10）分对（22.19 ± 7.22）分；t = 1.202，P = 0.039］。两组患者术后面部感觉迟钝、头痛、恶心呕吐等并发症发生率均较高，肺炎、颅内感染、脑脊液漏、深静脉血栓形成、不完全性面瘫、听力缺失、运动障碍等并发症少见，无一例死亡，其中，MVD 组术后面部感觉迟钝发生率低于非手术治疗组［8.75%（7/80）对86.79%（46/53）；χ² = 81.005，P = 0.000］。结论 微血管减压术治疗老年原发性三叉神经痛安全、有效，因此建议除非无法耐受全身麻醉，原发性三叉神经痛患者均应首选微血管减压术。

关键词: 三叉神经痛, 显微外科手术, 老年人

Abstract:

Objective  To compare the efficacy and safety of microvascular decompression (MVD) and non-surgical treatment for treating senile idiopathic trigeminal neuralgia (ITN).  Methods  A total of 133 patients older than 75 years with ITN respectively received MVD (N = 80) and non-surgical treatments (N = 53) such as pulse radiofrequency in 38 cases, stereotactic gamma knife radiotherapy in 10 cases, and acupuncture and moxibustion in 5 cases. McGill Pain Questionnaire (MPQ) was used to evaluate the degree of pain improvement. World Health Organization Quality of Life Scale-100 (WHOQoL-100) was used to evaluate life quality. Postoperative complications were recorded, including facial blunt sensation, headache, nausea and vomiting, pneumonia, intracranial infection, cerebrospinal fluid (CSF) leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia.  Results  In MVD group, 79 cases (98.75%) had complete pain relief and one case (1.25%) had partial pain relief after operation. There were 8 cases (15.09% ) with complete pain relief, 33 cases (62.26% ) with partial pain relief, and 12 cases (22.64% ) without pain relief in non-surgical treatment group. The difference between 2 groups was statistically significant (χ² = 84.241, P = 0.000). After 55.80 (35.74, 63.48) months follow-up, the recurrence rate of MVD group was significantly lower than that of non-surgical treatment group [8.75% (7/80) vs. 35.85% (19/53); χ²= 16.558, P = 0.000]. The life quality of MVD group was better than that of non-surgical treatment group [WHOQoL-100 (27.82 ± 2.10) score vs. (22.19 ± 7.22) score; t = 1.202, P = 0.039]. The occurrence of postoperative complications such as facial blunt sensation, headache, nausea and vomiting were high in both groups, while the occurrence of pneumonia, intracranial infection, CSF leakage, deep venous thrombosis, incomplete facial paralysis, hearing loss and dyskinesia were rare in both groups. No case was dead. The incidence of facial blunt sensation in MVD group was significantly lower than that in non-surgical treatment group [8.75% (7/80) vs. 86.79% (46/53); χ² = 81.005, P = 0.000]. Conclusions  MVD is safe and effective in the treatment of senile ITN, so it is suggested that MVD should be the first choice for patients with ITN, unless they cannot tolerate general anesthesia.

Key words: Trigeminal neuralgia, Microsurgery, Aged