摘要：

目的  探讨不同责任血管数目的三叉神经痛患者行微血管减压术的有效性和安全性。方法 采用微血管减压术治疗 80 例原发性三叉神经痛患者（包括单责任血管 48 例、多责任血管 32 例），视觉模拟评分（VAS）评价疼痛程度，Brisman 标准评价疗效并计算总有效率，记录术后并发症（包括发热、口角麻木、听力下降、短暂性滑车神经麻痹、手术切口红肿）和术后 1 年三叉神经痛复发率。结果 两组患者术后 VAS 评分低于术前且差异有统计学意义（F = 5.871，P = 0.000），VAS 评分组间差异无统计学意义（F = 1.192，P = 0.318）。单责任血管组 48 例患者中治愈 40 例（83.33%）、显效 4 例（8.33%）、有效 2 例（4.17%），总有效率 95.83%（46/48）；7 例（14.58%）出现术后并发症，包括发热 4 例（8.33%）、口角麻木 1 例（2.08%）、短暂性滑车神经麻痹 2 例（4.17%）；2 例（4.17%）复发。多责任血管组 32 例患者中治愈 27 例（84.38%）、显效 3 例（9.38%）、有效 1 例（3.13%），总有效率 96.88%（31/32）；6 例（18.75%）出现术后并发症，包括发热 4 例（12.50%）、听力下降 1 例（3.13%）、手术切口红肿 1 例（3.13%）；2 例（6.25%）复发。两组总有效率（χ² = 1.863，P = 0.485）、术后并发症发生率（χ²= 2.119，P = 0.378）和复发率（校正χ² = 2.075，P = 0.391）差异均无统计学意义。结论 微血管减压术治疗单责任血管和多责任血管的三叉神经痛具有相似的疗效和安全性，具有临床应用价值。

关键词: 三叉神经痛, 显微外科手术

Abstract:

Objective  To investigate the influence of the number of offending vessels on clinical efficacy and safety of microvascular decompression (MVD) in the treatment of trigeminal neuralgia (TN).  Methods  A total of 80 idiopathic TN patients underwent MVD were divided into 2 groups: single offending vessel group (N = 48) and multiple offending vessels group (N = 32). Visual Analogue Scale (VAS) was used to evaluate the degree of pain before and after surgery. Brisman Standard was used to evaluate curative effect and calculate total effective rate. Postoperative complications (fever, angular numbness, hearing loss, transient trochlear nerve palsy, swelling of incision) and recurrence rate one year after MVD were recorded. Results  The VAS scores of 2 groups after operation were significantly lower than before operation (F = 5.871, P = 0.000). There was no significant difference on VAS scores between 2 groups (F = 1.192, P = 0.318). In 48 patients of single offending vessel group, 40 cases (83.33%) were cured, 4 cases (8.33%) had obvious effect, 2 cases (4.17%) were improved and 2 cases (4.17%) had no effect. The total effective rate was 95.83% (46/48). Seven cases (14.58%) presented postoperative complications, including fever in 4 cases (8.33%), angular numbness in one case (2.08%), transient trochlear nerve palsy in 2 cases (4.17%). TN recurred in 2 cases (4.17%). In 32 patients of multiple offending vessels group, 27 cases (84.38%) were cured, 3 cases (9.38%) had obvious effect, one case (3.13%) was improved and one case (3.13% ) had no effect. The total effective rate was 96.88% (31/32). Six cases presented postoperative complications, including fever in 4 cases (12.50%), hearing loss in one case (3.13%), swelling of incision in one case (3.13%). TN recurred in 2 cases (6.25%). There were no significant differences in total effective rate (χ² = 1.863, P = 0.485), incidence of postoperative complication (χ²= 2.119, P = 0.378) and postoperative recurrence rate (adjusted χ² = 2.075, P = 0.391) between 2 groups. Conclusions  MVD has similar clinical effects and safety in the treatment of TN patients with single or multiple offending vessels.

Key words: Trigeminal neuralgia, Microsurgery