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临床上原发性三叉神经痛表现为神经分布区域短暂的发作性疼痛,目前保守方法为口服药物治疗,如卡马西平等。但常因为口服药物剂量增加导致的严重不良反应,以及病人疼痛难忍不能耐受而被迫中止[1]。临床上常见的外科治疗方法有经皮穿刺微球囊压迫术(percutaneous microballoon compression,PMC)、半月节射频热凝术、开颅微血管减压术(microvascular decompression,MVD)[2]、γ刀等[3-6]。微球囊压迫术治疗自发明以来已有37年的历史,在世界各国得到了广泛的运用,TATLI等[7]通过回顾性研究发现PMC和MVD的疗效相近,优于其他方法,但传统C臂机下引导穿刺有一定盲目性,无法实时动态观察穿刺方向,导致术中穿刺损伤,增加并发症发生率。本研究比较比较数字减影血管造影(DSA)与传统C臂机引导微球囊压迫术治疗三叉神经痛的临床疗效和并发症。现作报道。
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DSA组一次性穿刺成功率、入射体表剂量均高于C臂机组(P < 0.05和P < 0.01),DSA组手术时间明显低于C臂机组(P < 0.01),2组临床有效率差异无统计学意义(P>0.05)(见表 1)。
分组 n 一次性穿刺成功率 手术时间/min 入射体表剂量/mGy 临床有效率 DSA组 20 18(90.0) 25.10±7.30 49.75±12.50 19(95.0) C臂机组 25 15(60.0) 46.70±6.00 9.68±3.92 22(88.0) t — 5.11# 10.90 15.16 0.67# P — < 0.05 < 0.01 < 0.01 >0.05 #示χ2值 表 1 2组一次性穿刺成功率、手术时间、入射体表剂量、临床有效率比较(x±s)
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C臂机组并发症发生率高于DSA组(P < 0.05)(见表 2)。
分组 n 咬肌无力 单纯疱疹 复视 三叉神经抑制反应 颅内出血 合计 χ2 P DSA组 20 1(5.0) 2(10.0) 0(0.0) 1(5.0) 0(0.0) 4(20.0) 4.84 < 0.05 C臂机组 25 3(12.0) 6(24.0) 1(4.0) 3(12.0) 0(0.0) 13(52.0) 合计 45 4(8.89) 8(17.78) 1(2.22) 4(8.89) 0(0.00) 17(37.78) 表 2 2组手术并发症发生率比较[n;百分率(%)]
DSA与传统C臂机引导微球囊压迫术治疗三叉神经痛的疗效比较
Comparison of efficacy between DSA and traditional C-arm machine guided microballoon compression for trigeminal neuralgia
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摘要:
目的比较数字减影血管造影(DSA)与传统C臂机引导微球囊压迫术治疗三叉神经痛的临床疗效和并发症。 方法选取原发性三叉神经痛病人45例, 分为DSA组(n=20)和C臂机组(n=25)。DSA组采用DSA机精准引导微球囊压迫术, C臂机组采用传统C臂机引导微球囊压迫术, 比较2组病人的一次性穿刺成功率、手术时间、X线入射体表剂量、临床疗效和并发症发生率。 结果DSA组一次性穿刺成功率、入射体表剂量均高于C臂机组(P < 0.05和P < 0.01);DSA组手术时间明显低于C臂机组(P < 0.01);2组临床有效率差异无统计学意义(P>0.05)。C臂机组并发症发生率高于DSA组(P < 0.05)。 结论2种手术方式都有较好临床疗效, DSA引导微球囊压迫术具有提高一次性穿刺成功率、缩短手术时间和降低并发症的优点, 具有较高的临床应用和推广价值。 Abstract:ObjectiveTo compare the clinical efficacy and complications between digital subtraction angiography(DSA) and traditional C-arm machine guided microballoon compression for trigeminal neuralgia. MethodsForty-five patients with primary trigeminal neuralgia were divided into DSA group(n=20) and C-arm group(n=25).DSA group was treated with precise guidance of DSA machine, and C-arm group was treated with traditional C-arm machine.The success rate of one-time puncture, operation time, entrance surface dose of X-ray, clinical efficacy rate and complication rate in the two groups were compared. ResultsThe success rate of one-time puncture and entrance surface dose of X-ray in DSA group were higher than those in C-arm group(P < 0.05 and P < 0.01), the operation time in DSA group was significantly lower than that in C-arm group(P < 0.01), and there was no significant difference in clinical efficacy rate between the two groups(P>0.05).The complication rate in C-arm group was higher than that in DSA group(P < 0.05). ConclusionsThe two methods have high clinical efficacy, DSA guided microballoon compression has the advantages of improving the success rate of one-time puncture, shortening the operation time and reducing complications, and has a high clinical application and promotion value. -
表 1 2组一次性穿刺成功率、手术时间、入射体表剂量、临床有效率比较(x±s)
分组 n 一次性穿刺成功率 手术时间/min 入射体表剂量/mGy 临床有效率 DSA组 20 18(90.0) 25.10±7.30 49.75±12.50 19(95.0) C臂机组 25 15(60.0) 46.70±6.00 9.68±3.92 22(88.0) t — 5.11# 10.90 15.16 0.67# P — < 0.05 < 0.01 < 0.01 >0.05 #示χ2值 表 2 2组手术并发症发生率比较[n;百分率(%)]
分组 n 咬肌无力 单纯疱疹 复视 三叉神经抑制反应 颅内出血 合计 χ2 P DSA组 20 1(5.0) 2(10.0) 0(0.0) 1(5.0) 0(0.0) 4(20.0) 4.84 < 0.05 C臂机组 25 3(12.0) 6(24.0) 1(4.0) 3(12.0) 0(0.0) 13(52.0) 合计 45 4(8.89) 8(17.78) 1(2.22) 4(8.89) 0(0.00) 17(37.78) -
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