唐晓宇　吴刚　马冕　邓朋　樊犇　吴建东

[摘要] 目的 探討三叉神经微血管减压术在三叉神经痛患者治疗中的安全性和有效性。 方法 选取2016年11月至2020年9月我院收治的三叉神经痛患者63例，其中采用三叉神经微血管减压术治疗的30例设为观察组，采用中医电针治疗的33例患者设为对照组，对比分析两组患者的治疗效果。 结果 观察组中症状缓解26例，总有效率为86.67%（26/30），对照组症状缓解21例，总有效率为63.64%（21/33），观察组明显高于对照组（P<0.05）;观察组平均随访时间为（20.53±12.41）个月，1例出现复发（3.33%），对照组随访时间为（18.41±10.48）个月，复发率为36.36%（12/33），复发率明显低于对照组（P<0.05）。观察组1例发生脑脊液漏，对照组无特殊并发症。 结论 微血管减压术治疗三叉神经痛安全有效，术中应注意辨别责任血管，充分减压三叉神经以提高手术疗效并减少并发症。

[关键词] 三叉神经痛;微血管减压术;责任血管;并发症

[中图分类号] R651.1          [文献标识码] B          [文章编号] 1673-9701（2021）06-0071-04

Clinical efficacy of trigeminal nerve microvascular decompression in the treatment of trigeminal neuralgia

TANG Xiaoyu1   WU Gang1   MA Mian1   DENG Peng1   FAN Ben2   WU Jiandong1

1.Department of Neurosurgery， Suzhou Municipal Hospital affiliated to Nanjing Medical University， Suzhou   215002，China; 2.Department of Traditional Chinese Medicine， Suzhou Municipal Hospital affiliated to Nanjing Medical University， Suzhou   215002， China

[Abstract] Objective To explore the safety and effectiveness of microvascular decompression of trigeminal nerve in the treatment of patients with trigeminal neuralgia. Methods A total of 63 patients with trigeminal neuralgia treated in our hospital from November 2016 to September 2020 were collected and studied. Among them， 30 patients treated with microvascular decompression of trigeminal nerve were set as the observation group， and 33 patients treated with electroacupuncture of traditional Chinese medicine were set as the control group. The therapeutic effects of the two groups were compared and analyzed. Results The total effective rate was 86.67%（26/30） in the observation group， and 63.64% （21/33） in the control group. The observation group was significantly higher than the control group（P<0.05）. The average follow-up time of the observation group was （20.53±12.41） months， and 1 case had recurrence （3.33%）. The follow-up time of the control group was （18.41±10.48） months， and the recurrence rate was 36.36% （12/33）. The recurrence rate in the treatment group was significantly lower than that in the control group（P<0.05）. Cerebrospinal fluid leakage occurred in 1 case in the observation group， and there was no special complication in the control group. Conclusion Microvascular decompression is safe and effective in the treatment of trigeminal neuralgia. Attention should be paid to identify the responsible vessels and decompress the trigeminal nerve sufficiently to improve the curative effect and reduce complications.

[Key words] Trigeminal neuralgia; Microvascular decompression; Offending vessel; Complication

三叉神经痛（Trifacial neuralgia，TN）是以三叉神经支配区皮肤突发的，阵发性疼痛为主要特征的一种神经功能性疾病，其发病率大约为4～5/10万[1]。由于疼痛剧烈，往往会对工作生活造成严重影响。TN的病因复杂，可分为原发性及继发性，继发性TN可由桥小脑角区占位，包括颅内肿瘤、多发性硬化及三叉神经的脱髓鞘病变等引起。而原发性TN的病因目前仍有争议，其中血管压迫学说被广泛的接受：三叉神经在半月结至入脑干处的感觉根被血管压迫，造成三叉神经脱髓鞘改变并发生异常放电而引起剧烈疼痛。乙状窦后入路行三叉神经微血管减压术（Microvascular decompression，MVD）是原发性三叉神经痛主要的治疗方式，但因其病因多样、责任血管判断困难等原因导致研究结果不尽相同。本研究旨在分析三叉神经微血管减压术的临床疗效，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2016年11月至2020年9月南京……