摘要
目的对比观察CT引导下颅外非半月神经节三叉神经分支射频热凝与传统的半月节射频热凝镇痛技术在80岁以上高龄患者中的临床效果。方法对确诊为原发性三叉神经痛的41例80岁以上高龄患者,22例于CT定位引导下经患侧眶上孔、圆孔、卵圆孔穿刺行非半月节射频热凝治疗作为观察组,并与另19例接受传统经皮卵圆孔穿刺半月节射频热凝治疗的患者作对照。观察2组治疗的操作时间、疗效(术后即刻、术后1周、1个月、6个月、12个月、24个月)和并发症。结果 2组患者均于CT引导下穿刺进入相应眶上孔和/或圆孔及卵圆孔,射频热凝治疗均获得了即刻和持久镇痛效果,但非半月节组治疗操作时间显著短于传统半月神经节射频组[(27.92±8.46)min vs.(46.87±23.13)min,P<0.01],并发症更少(角膜溃疡:(0/22 vs.1/19),非疼痛区感觉减退(0/22 vs.4/19),而面部血肿发生率和两年复发率相当(5/22 vs.6/19、2/22 vs.1/19)。结论 CT引导下颅外非半月节射频热凝和传统的经皮卵圆孔穿刺半月节射频热凝技术均能有效治疗原发性三叉神经痛,但前者比后者具有更高的分支选择性,且操作更加快捷,更适合用于80岁以上全身情况较差的高龄原发性三叉神经痛患者的有效治疗。
Objective To compare the results of CT-guided radiofrequency thermocoagulation of individual trigeminal subbranch nerve（ RFTi） with conventional radiofrequency thermocogulation of the Gasserian ganglion（ RFTG） for trigeminal neuralgia（ TN） patients older than 80 years. Methods Forty-one qualified patients who older than 80 years were enrolled. The first procedure undertaken was RFTi in 22 patients and RFTG in 19 patients. The following outcome measures were assessed in both groups： pain relief（ immediate postoperative,postoperative 1 week,and 1,6,12,and 24 months were recorded）,procedural time,and adverse outcomes. Results All patients in the CT-guided needle into the corresponding hole（ supraorbital hole and / or the foramen roundum and the foramen ovale）,both groups had good immediate and sustained pain relief. But RTFi group spent shorter procedural time than the RFTG group（ 27. 92 ± 8. 46 vs. 46. 87 ± 23. 13 minutes,P〈0. 05）,and had fewer adverse outcomes including corneal ulcer（ 0 /22 vs. 1 /19） and original non-painful area hypoesthesia（ 0 /22 vs. 4 /19）. Conclusion Both RFTi and RFTG were satisfactory strategies for treating original TN.Radiofrequency thermocoagulation of individual trigeminal sub-branch nerve was a safer and more effective choice for TN patients 80 years or older,including poor-fitness patients.
出处
《中华全科医学》
2015年第5期706-708,758,共4页
Chinese Journal of General Practice
基金
浙江省医药卫生平台骨干人才计划A类项目(2013-RCA042)
浙江省科技厅社会公益类项目(2012C33092)
浙江省中西医结合疼痛医学重点创新学科基金(2012-XK-A31)
浙江省嘉兴市科技项目(2011AY-1050-1)
关键词
三叉神经痛
高龄
射频热凝
非半月节
Trigeminal neuralgia
Advanced age
Radiofrequency thermo-coagulation
Non-semilunar ganglion
作者简介
通信作者：黄冰，E-mail：jxhb999@sina．com
