1、老年特发性三叉神经痛应用微血管减压与伽玛刀放射外科术的疗效比拟【】目的 探讨老年特发性三叉神经痛应用微血管减压与伽玛刀放射外科术的疗效差异 方法 选择2023年11月至2023年11月我院接诊的90例特发性三叉神经痛的老年患者，通过手术方式不同分为微血管减压组n=45和伽玛刀组n=45，比拟两组术后3个月疗效，并进行12个月随访，记录术前术后视觉模拟评分法VAS，并记录并发症以及疼痛复发率。结果 两组术后3个月疗效总缓解率比拟无显著差异88.89%40/45vs82.22%37/45P0.05；两组术后VAS评分较治疗前均得到显著降低P0.05，两组术后1个月VAS评分比拟无显著差异P0.05
2、，但微血管减压组在术后3个月、6个月、9个月、12个月时VAS评分均明显比伽玛刀组低，比拟均具有统计意义P0.05；两组术后感染、恶心呕吐、耳鸣、面部麻木、听力障碍总发生率比拟无显著差异17.78%8/45vs15.56%7/45P0.05；在12个月的随访过程中，微血管减压组疼痛复发率明显比伽玛刀组低11.11%5/45vs28.89%13/45，差异具有统计学意义P0.05。结论 微血管减压术和伽马刀放射术均可缓解老年特发性三叉神经痛，但微血管减压术在远期疼痛缓解率和复发率上均优于伽马刀放射术，更利于根底状况良好的老年患者治疗，但对于根底情况较差或不能耐受手术的患者，伽马刀放射术也可以作为
3、较好的姑息治疗术式。【关键词】老年特发性三叉神经痛；微血管减压术；伽玛刀放射术；疼痛Comparison of microvascular decompression and gamma knife radiosurgery inthe treatment of idiopathic trigeminal neuralgia in the elderly【Abstract】 Objective To study the curative effect difference of microvascular decompression and gamma knife radiosurgery i
4、n the treatment of idiopathic trigeminal neuralgia in the elderly. Methods 90 patients of idiopathic trigeminal neuralgia in the elderly who received therapy from November 2023 to November 2023 in our hospital were selected. according to different surgical methods,those patients were divided into th
5、e microvascular decompression group (n=45) and the gamma knife group (n=45). The curative effect was compared between the two groups after 3 months, and the patients were followed up for 12 months, and the visual analogue scale (VAS) was recorded before and after the operation, and the complication
6、and pain recurrence rate were record. Results There was no significant difference in the total remission rate between the two groups after 3 months88.89%(40/45)vs82.22%(37/45)P0.05); the VAS scores in the two groups were significantly lower than those before treatment(P0.05), there was no significan
7、t difference in VAS score between the two groups after operation 1 months(P0.05), but the VAS scores inthe microvascular decompression group were significantly lower than those of the gamma knife group at after operation 3, 6, 9 and 12 months, the difference was statistically significant (P0.05); th
8、ere was no significant difference in the incidence of postoperative infection, nausea, vomiting, tinnitus, facial numbness and hearing impairment between the two groups17.78%(8/45)vs15.56%(7/45) (P0.05); the pain recurrence rate in the microvascular decompression group was significantly lower than t
9、hose of the gamma knife group at 12 months follow-up11.11%(5/45)vs28.89%(13/45), the difference was statistically significant (P0.05). Conclusion Microvascular decompression surgery and gamma knife radiotherapy can relieve senile idiopathic trigeminal neuralgia, but the microvascular decompression r
10、emission rate and recurrence rate were better than that of gamma knife radiation in long-term pain, its more conducive to the treatment of elderly patients with good foundation, But for the basis of poor or can not tolerate surgery, gamma knife radiosurgery also can be used as a good palliative trea
11、tment.【Keywords】Idiopathic trigeminal neuralgia in the elderly; Microvascular decompression; Gamma knife radiosurgery; Pain特发性三叉神经痛是临床上常见的多发病，其主要指由不明原因所致的三叉神经感觉根分布区出现阵发性疼痛，以一侧面部三叉神经分布区出血阵发性刀割样或闪电样疼痛为典型病症1。而在老年患者中，由于整体健康状况的降低，机体功能也不如青年人群，并常有糖尿病、高血压等根底疾病的伴随，罹患三叉神经痛可进一步影响生活质量，甚至可加重根底疾病2-3。对于该病的治疗方式较多，在
12、药物治疗中多使用奥卡西平、卡马西平等，但仅可产生短暂的缓解效果，且药物所产生的副作用较多，患者常难以耐受4。在外科手术中，主要包括微血管减压术和各类三叉神经消融术等，伽玛刀放射外科手术是近年来兴起的术式，并因其具有创伤小、疗效高等特点，已受到较多学者重视；而微血管减压术作为经典的特发性三叉神经痛治疗术式，也已广泛应用到该病的治疗中5-6。但临床上对这两个术式用于老年特发性三叉神经痛中的疗效比拟报道较少，因此，本次研究通过在老年特发性三叉神经痛中分别应用微血管减压术和伽玛刀放射术，并比照其疗效差异，现报道如下。1资料与方法1.1 一般资料选择2023年11月至2023年11月我院接诊的90例特发
13、性三叉神经痛的老年患者。纳入标准：符合特发性三叉神经痛诊断标准7；年龄60岁；全身状况良好，耐受手术；患者及其家属知情同意此次研究。排除标准：经过MRI等检查排除由于其余疾病所引发的继发性三叉神经痛患者；合并颅内占位病变，例如脑膜瘤、三叉神经稍瘤、胆脂瘤；0.70年；疼痛部位左侧21例，右侧24例。此研究已获得我院伦理委员会批准实施，两组一般资料比拟差异不显著P0.05，具有可比性。1.2 方法微血管减压组：采取健侧卧位，气管插管全身麻醉，颈部略微弯曲，令患者乳突大致平行于手术台面并处于最高位置；将头部向健侧进行约10的旋转，头顶下垂约15，枕下乙状窦后入路，于耳后发际内乙状窦下竖切口作45c
14、m的切口，并在乙状窦前方处进行颅骨钻孔，直径大约在2.5cm，将硬膜剪开并悬吊，在显微镜的辅助下，将桥前池和枕大池蛛网膜挑开，令脑脊液缓慢流出，轻轻牵开小脑半球，仔细区分血管和神经，将责任血管确定后，使用纤维剪刀将蛛网膜钝性别离后，游离推移血管，并检查是否有责任血管的遗漏，确认无血管过度扭曲、牵张后，严格止血并冲洗创口，缝合硬脑膜，关颅。1.3 观察指标疼痛评分：对所有患者进行12个月的随访，使用视觉模拟评分法VAS对疼痛感进行记录，在纸上化一条10cm的横线，一端为0分，表示无疼痛，一端为10分，表示疼痛剧烈，叮嘱感觉以自身所感疼痛程度，在横线上作出标记；记录术后并发症；复发标准：疼痛得到半
15、年以上的缓解，但又发生相同性质的疼痛或疼痛范围有所改变，发作频繁，难以忍受。1.4 疗效评价参照Brisman等8提出的对三叉神经痛的疗效标准，治愈：术后无疼痛感；显效：术后疼痛缓解明显，偶有疼痛需服用药物治疗；好转：疼痛稍有缓解、服药量减少，或治疗前多支疼痛治疗后改善未单支疼痛；无效：疼痛感和术前比拟无明显改变。总缓解率=治愈+显效+好转。1.5 统计学分析以spss18.0软件包处理，计量资料用均数标准差s表示，组间、组内比拟均使用t检验，计数资料2检验，等级资料秩和检验，P0.05表示差异具有统计学意义。2 结果2.1 两组术后3个月疗效比拟两组术后3个月总缓解率分别为88.89%、82.22%，比拟无显著差异P0.05，见表1。表1两组术后3个月疗效比拟s组别例数治愈显效好转无效总缓解率微血管减压组452351.111124.44613.33511.114088.89伽玛刀组452044.44817.78920.00817.783782.22u/2值u2P值PP2.2 两组随访过程中VAS评分比拟两组术前VAS评分比拟差异不显著P0.05，两组术后VAS评分较治疗前均得到显著降低P0.05，两组术后1个月VAS评分比拟无显著差异P0.05，但微血管减压组在术后3个月、6个月、9个月、12个月
