张健　施恩标　丁培源

[摘要] 目的 探究CT下經皮穿刺半月神经节射频热凝治疗原发性三叉神经痛（PTN）临床效果。 方法 选取2015年5月～2016年8月上海交通大学医学院附属新华医院崇明分院收治的PTN患者86例，采用随机字母表法分为对照组与观察组，每组各43例，对照组患者经皮球囊压迫治疗，观察组患者采用CT下经皮穿刺半月神经节射频热凝治疗，比较两组患者临床疗效、疼痛程度、睡眠质量、生活质量、并发症发生情况及1年内复发情况。 结果 观察组患者治疗总有效率高于对照组，但差异无统计学意义（P > 0.05）。两组患者治疗后VAS及QS评分均有所下降，且观察组明显低于对照组，差异有高度统计学意义（P < 0.01）。两组治疗后生活质量各维度评分均显著提高，且观察组高于对照组，差异有统计学意义（P < 0.05）。观察组患者侧面颊部麻木及咀嚼肌肌力下降发生率均显著低于对照组，差异有统计学意义（P < 0.05），相邻支支配区疼痛及共济失调发生率与对照组比较，差异无统计学意义（P > 0.05）。观察组患者复发率显著低于对照组，差异有统计学意义（P < 0.05）。 结论 CT下经皮穿刺半月神经节射频热凝治疗PTN疗效确切，且能够有效减轻患者疼痛，提高睡眠质量与生活质量，降低并发症发生率与复发率。

[关键词] CT；经皮穿刺；半月神经节；射频热凝；经皮球囊压迫；原发性三叉神经痛

[中图分类号] R745 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0112-05

[Abstract] Objective To explore the clinical effect of percutaneous punctured hemifacial ganglia radiofrequency thermocoagulation on primary trigeminal neuralgia （PTN） under CT. Methods Eighty-six cases of PTN patients admitted to Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine， from May 2015 to August 2016 were selected， according to random number table method， they were divided into observation group （43 cases） and control group （43 cases）. Patients in the control group were treated with percutaneous balloon compression， patients in the observation group were treated with semilunar ganglion radiofrequency thermocoagulation under CT guidance. The clinical efficacy， pain， sleep quality， quality of life， complications and relapse within 1 year in the two groups were compared. Results The total effective rate in observation group was higher than that in control group， but the difference was not statistically significant （P > 0.05）. The VAS and QS scores in two groups decreased after treatment， and these in the observation group were significantly lower than those in the control group， the differences were statistically significant （P < 0.01）. The scores of quality of life in two groups increased significantly after treatment， these in the observation group were higher than those in the control group， the differences were statistically significant （P < 0.05）. The incidences of side cheek numbness and masticatory muscle descent in the observation group were significantly lower than that in the control group， the differences were statistically significant （P < 0.05）； and the incidence of pain and ataxia in adjacent branch areas in the observation group were conpared with the control group， the differences were not statistically significant （P > 0.05）. The recurrence rate of observation group was significantly lower than that of control group， the difference was statistically significant （P < 0.05）. Conclusion Semilunar ganglion radiofrequency thermocoagulation under CT guidance for the treatment of PTN is remarkable， and it can effectively reduce the patient′s pain， improve sleep quality and quality of life， reduce the complication rate and recurrence rate.

[Key words] CT； Percutaneous puncture； Semilunar ganglion； Radiofrequency thermocoagulation； Percutaneous balloon compression； Primary trigeminal neuralgia

原发性三又神经痛（primary trigeminal neuralgia，PTN）病变部位位于三叉神经分布区，以三叉神经第Ⅱ、Ⅲ发病率最高，临床症状主要表现为该区域发作性、短暂性剧痛。PTN可由轻微刺激或面部运动诱发，但确切病因不明确，药物为首选治疗方案，通常治疗效果不理想，且疗效随用药时间延长而逐渐下降[1]。临床研究发现[2]，经皮球囊压迫术治疗PTN效果确切，但并发症较多，使其临床应用受限。经皮穿刺半月神经节射频热凝是目前治疗PTN的有效方法之一，具有微创、定位准确的特点。有研究指出[3]，该技术在穿刺过程中需要反复调整穿刺针方向，易对周围组织造成损伤，从而引发并发症。本……