1、海南医学2023年4月第34卷第8期Hainan Med J,Apr.2023,Vol.34,No.8面肌痉挛微血管减压术中不同面肌的侧方扩散反应及其临床意义魏文渊，别小华，薛俊刚西安交通大学附属红会医院神经外科，陕西西安710000【摘要】目的探讨面肌痉挛(HFS)微血管减压术(MVD)中不同面肌的侧方扩散反应(LSR)及其临床意义。方法回顾性分析2019年1月至2022年1月西安交通大学附属红会医院收治且行MVD治疗的290例HFS患者的临床资料，将MVD术中监测LSR的210例患者纳入监测组，术中未监测LSR的80例患者纳入对照组。比较两组患者术后1周、术后3个月时的MVD疗效；分析监测
2、组患者术中LSR的变化，比较LSR未消失和消失患者术后1周、术后3个月时的MVD疗效；比较LSR提前消失和减压消失患者术后1周、术后3个月时MVD疗效。结果术后1周、术后3个月时，监测组患者的MVD疗效明显优于对照组，差异均有统计学意义(P0.05)；监测组患者MVD手术中，98.09%(206/210)患者术中LSR消失，1.91%(4/210)患者面神经减压后LSR未消失，消失患者中15.05%(31/206)患者LSR在完成面神经减压前消失，84.95%(175/206)患者LSR在完成面神经减压后消失。术后1周时，LSR消失患者的MVD疗效明显优于未消失患者，差异有统计学意义(P0.0
3、5)。术后1周、术后3个月时，LSR提前消失患者的MVD疗效与LSR减压消失患者比较差异无统计学意义(P0.05)。结论MVD治疗HFS患者术中监测LSR有利于手术顺利进行，提高手术治疗疗效，且MVD术中LSR消失的近期疗效优良，LSR消失时机对HFS患者远期疗效无明显影响。【关键词】面肌痉挛；微血管减压术；侧方扩散反应；近期疗效；远期疗效【中图分类号】R782.05【文献标识码】A【文章编号】10036350（2023）08111405Lateral spread response of different facial muscles during microvascular decomp
4、ression for hemifacial spasm andits clinical significance.WEI Wen-yuan,BIE Xiao-hua,XUE Jun-gang.Department of Neurosurgery,Honghui HospitalAffiliated to Xian Jiaotong University,Xian 710000,Shaanxi,CHINA【Abstract】ObjectiveTo explore the lateral spread response(LSR)of different facial muscles during
5、 microvas-cular decompression(MVD)for hemifacial spasm(HFS)and its clinical significance.MethodsThe clinical data of290 patients with HFS who underwent MVD treatment in Honghui Hospital Affiliated to Xian Jiaotong University wereretrospectively analyzed between January 2019 and January 2022.A total
6、of 210 patients with LSR monitoring duringMVD surgery were included in the monitoring group,and the remaining 80 cases without LSR monitoring during sur-gery were enrolled as the control group.The MVD efficacy at 1 week and 3 months after surgery was compared betweentwo groups,and the changes of LSR
7、 in monitoring group were analyzed during surgery.The MVD efficacy at 1 weekand 3 months after surgery was compared between patients without LSR disappearance and patients with LSR disappear-ance.The efficacy of MVD was compared between patients with early disappearance of LSR and patients with deco
8、m-pression disappearance at 1 week and 3 months after surgery.ResultsAt 1 week and 3 months after operation,the effi-cacy of MVD in the monitoring group was significantly better than that in the control group,with statistically significantdifferences(P0.05).During MVD surgery in the monitoring group
9、,98.09%(206/210)of the patients lost the LSR dur-ing surgery and 1.91%(4/210)of the patients did not lose the LSR after facial nerve decompression,15.05%(31/206)had LSR disappeared before facial nerve decompression and 84.95%(175/206)had LSR disappeared after facial nervedecompression.The efficacy o
10、f patients with LSR disappearance at 1 week after surgery was significantly better thanthat of patients without LSR disappearance(P0.05).There was no significant differencein the efficacy of MVD between the patients without LSR disappearance and the patients with LSR disappearance at 3months after s
11、urgery(P0.05).At 1 week and 3 months after surgery,there was no significant difference in the efficacy ofMVD between patients with LSR early disappearance and patients with LSR decompression disappearance(P0.05).ConclusionIntraoperative monitoring of LSR in patients with HFS treated with MVD facilit
12、ates the smooth operation,and improves the efficacy of surgical treatment.The short-term efficacy of LSR disappearance during MVD surgery isexcellent,and the timing of LSR disappearance has no significant effect on the long-term efficacy of HFS patients.【Key words】Hemifacial spasm;Microvascular deco
13、mpression;Lateral spread response;Short-term efficacy;Long-term efficacy 论著 doi:10.3969/j.issn.1003-6350.2023.08.010基金项目：陕西省重点研发计划项目(编号：2022SF-100)。第一作者：魏文渊(1987)，男，主治医师，硕士研究生，主要研究方向为神经外科。通讯作者：薛俊刚(1981)，男，主治医师，硕士研究生，主要研究方向为神经外科，E-mail：。1114Hainan Med J,Apr.2023,Vol.34,No.8海南医学2023年4月第34卷第8期面肌痉挛(hemi
14、facial spasm，HFS)为神经内科常见疾病之一，其临床症状表现为患者面部神经及其支配的肌肉出现不自主抽搐，对患者日常生活、沟通交流等造成较大影响1。HFS大多为原发性疾病，为患者面部神经受到血管压迫导致，非手术治疗的治疗周期较长，且效果不理想，易复发，因此临床通常使用手术进行根治2。微血管减压术(microvascular decom-pression，MVD)为目前临床首选治疗 HFS 的治疗方式，MVD虽然可有效治疗HFS患者，但手术过程中准确判断责任血管、充分减压直接影响MVD治疗效果以及后续并发症发生风险3。侧方扩散反应(lateralspread response，LSR)
15、为患者异常肌电反应，刺激HFS患者面神经分支阈时，患者其他分支支配肌肉也可检测到类似肌电反应，可反映出患者神经肌肉是否存在异常4。MVD手术中是否监测LSR、LSR消失情况均可能对治疗效果造成影响。本研究主要分析HFS患者MVD手术中不同LSR情况的术后疗效，现将结果报道如下：1资料与方法1.1一般资料回顾性分析2019年1月至2022年1月西安交通大学附属红会医院收治且行MVD治疗的290例HFS患者的临床资料。纳入标准：确诊为原发性HFS5；单侧发病；经药物治疗后疗效不好；症状严重需实施手术治疗者；第一次实施MVD治疗。排除标准：高龄患者；合并高血压、器官衰竭等疾病无法耐受手术者；合并其他
16、面部疾病；合并其他颅脑神经性疾病；继发性HFS；HFS治疗后复发者；术前存在听力障碍者；合并凝血功能障碍者；无法配合随访复查者。将MVD术中监测LSR的210例患者纳入监测组，术中未监测LSR的80例患者纳入对照组。两组患者的一般资料比较差异均无统计学意义(P0.05)，具有可比性，见表1。本研究经医院医学伦理委员会批准。表1两组患者的一般资料比较x-s，例(%)Table 1Comparison of general data between the two groups of patients x-s,n(%)组别监测组对照组t/2/Z值P值例数21080年龄(岁)46.7214.3148.5114.240.9530.341病程(年)0.810.250.790.260.6020.548男性88(41.90)26(32.50)女性122(58.10)54(67.50)2.1480.143级67(31.90)26(32.50)级108(51.43)46(57.50)级35(16.67)8(10.00)0.7340.463性别HFS分级1.2治疗方法两组患者均行MVD治疗。全麻后取患者侧
