本文關(guān)鍵詞： 神經(jīng)內(nèi)鏡 顯微鏡 三叉神經(jīng)痛 微血管減壓術(shù)　出處：《山東大學》2017年碩士論文　論文類型：學位論文

【摘要】：研究背景三叉神經(jīng)痛是一種國內(nèi)外常見疾病,其臨床表現(xiàn)特點為面部有三叉神經(jīng)分布的區(qū)域出現(xiàn)反復短暫性、發(fā)作性、電擊樣劇烈疼痛,使病人的身心健康受到嚴重危害。目前在臨床上,三叉神經(jīng)痛通常被分為原發(fā)性和繼發(fā)性兩個大類別。原發(fā)性三叉神經(jīng)痛的治療方法包括封閉療法、射頻熱凝、藥物治療、三叉神經(jīng)微血管減壓手術(shù)等多種不同方式,其中三叉神經(jīng)微血管減壓術(shù)為當前治療原發(fā)性三叉神經(jīng)痛的被臨床工作者普遍接受的首選手術(shù)方法。三叉神經(jīng)痛微血管減壓手術(shù)最初的施行是在傳統(tǒng)顯微鏡下進行手術(shù),近年來,隨著神經(jīng)內(nèi)鏡技術(shù)的不斷發(fā)展,神經(jīng)內(nèi)鏡在神經(jīng)外科手術(shù)領(lǐng)域的應用不斷拓展,單純神經(jīng)鏡下原發(fā)性三叉神經(jīng)痛微血管減壓術(shù)的開展因其微創(chuàng)、視野清晰等諸多方面的優(yōu)勢而逐漸成為主流。研究目的目前,神經(jīng)內(nèi)鏡技術(shù)已經(jīng)成為微創(chuàng)神經(jīng)外科的重要組成部分,隨著設(shè)備的改進與手術(shù)技術(shù)的發(fā)展進步,其應用領(lǐng)域逐漸擴大。本研究對比分析單純神經(jīng)內(nèi)鏡下微血管減壓術(shù)與傳統(tǒng)顯微鏡下微血管減壓術(shù)治療原發(fā)性三叉神經(jīng)痛的有關(guān)資料,探討和評價單純神經(jīng)內(nèi)鏡在三叉神經(jīng)痛治療應用中的安全性和優(yōu)越性,為三叉神經(jīng)痛治療實踐中對不同手術(shù)方式進行選擇提供可靠臨床依據(jù)。資料與方法對山東大學齊魯醫(yī)院神經(jīng)外科2013年12月至2016年12月期間,收治的162例原發(fā)性三叉神經(jīng)痛患者治療的臨床資料和術(shù)后隨訪結(jié)果(其中67例行單純神經(jīng)內(nèi)鏡下微血管減壓術(shù),95例行傳統(tǒng)顯微鏡下微血管減壓術(shù))進行回顧性分析。分析比較單獨采用神經(jīng)內(nèi)鏡手術(shù)與傳統(tǒng)顯微鏡下手術(shù)的相關(guān)指標。對手術(shù)切口及術(shù)中所見視野顯露情況進行比較,對患者的一般資料、手術(shù)平均時間、術(shù)中平均出血量、術(shù)后平均住院時間的差異;術(shù)后疼痛緩解情況;術(shù)中其他中樞神經(jīng)損傷情況,出現(xiàn)面部麻木、面癱、聽力減退、腦脊液漏、感染等并發(fā)癥的發(fā)生情況及疼痛復發(fā)情況等分別進行統(tǒng)計對比分析,并對疼痛復發(fā)情況做Kaplan-Meier分析。研究中計量資料的比較采取t檢驗的方法,計數(shù)資料的比較采取卡方檢驗的方法,防止復發(fā)函數(shù)做Kaplan-Meier分析,檢驗水準以P0.05認為有統(tǒng)計學差異。主要結(jié)果本研究納入研究的171例原發(fā)性三叉神經(jīng)痛患者中,實際隨訪到了 162人,隨訪率94.74%。隨訪到的患者中行單純神經(jīng)內(nèi)鏡手術(shù)的有67人,行傳統(tǒng)顯微鏡下手術(shù)的有95人。單純神經(jīng)內(nèi)鏡組65人完全緩解,2人部分緩解,手術(shù)完全緩解率97.01%;手術(shù)時間70～100min,平均85.31min;術(shù)中出血量20～40ml,平均30.70ml;術(shù)后住院時間5～8d,平均6.209d;術(shù)后2例患者出現(xiàn)患側(cè)麻木,經(jīng)治療后好轉(zhuǎn),術(shù)后并發(fā)癥發(fā)生率2.99%;術(shù)后3人復發(fā),復發(fā)率4.48%。傳統(tǒng)顯微鏡組83人完全緩解,12人部分緩解,手術(shù)完全緩解率87.37%;手術(shù)時間85～120min,平均102.6min;術(shù)中出血量50～150ml,平均104.7ml;術(shù)后住院時間6～11d,平均8.649d;術(shù)后6例患者出現(xiàn)面部麻木,5例患者有舌面部麻木,2例患者出現(xiàn)耳鳴,1例患者述頭暈,均經(jīng)治療后好轉(zhuǎn),并發(fā)癥發(fā)生率14.74%;術(shù)后14人復發(fā),復發(fā)率14.74%。隨訪期間無死亡病例。神經(jīng)內(nèi)鏡組與顯微鏡組均能有效緩解癥狀,但神經(jīng)內(nèi)鏡相對更佳(P=0.0314),而神經(jīng)內(nèi)鏡組在平均手術(shù)時間(P0.0001)、術(shù)中出血量(P0.0001)、術(shù)后住院時間(P0.0001)、并發(fā)癥發(fā)生率(P=0.0135)以及術(shù)后疼痛復發(fā)率(P=0.0359)等方面顯著優(yōu)于顯微鏡組,差異有統(tǒng)計學意義。結(jié)論與建議單純神經(jīng)內(nèi)鏡下微血管減壓術(shù)與傳統(tǒng)顯微鏡下微血管減壓術(shù)治療原發(fā)性三叉神經(jīng)痛均有良好效果,手術(shù)療效滿意,安全性高,但單純神經(jīng)內(nèi)鏡下微血管減壓術(shù)在平均手術(shù)時間、術(shù)中出血量、術(shù)后住院時間、并發(fā)癥發(fā)生情況等方面更優(yōu)于顯微鏡下手術(shù),單純神經(jīng)內(nèi)鏡下微血管減壓術(shù)是治療原發(fā)性三叉神經(jīng)痛的較佳選擇,有向臨床進一步推廣的意義。與此同時,單純神經(jīng)內(nèi)鏡的手術(shù)應用對手術(shù)操作者的技巧與經(jīng)驗有較高要求,應進一步加強單純神經(jīng)內(nèi)鏡下原發(fā)性三叉神經(jīng)痛微血管減壓手術(shù)的拓展學習與培訓。
[Abstract]:The research background of trigeminal neuralgia is a common disease at home and abroad, its clinical features for facial trigeminal nerve distribution area of recurrent transient episodes of severe pain, shock like, make the patient's physical and mental health seriously. At present in the clinic, the trigeminal nerve pain is usually divided into primary and the secondary two categories. Treatment of primary trigeminal neuralgia including closed therapy, radiofrequency ablation, drug therapy, microvascular decompression for trigeminal neuralgia and so many different ways, including microvascular decompression of the trigeminal nerve for the treatment of primary trigeminal neuralgia is accepted by clinical workers preferred surgical method. The implementation of microvascular decompression for trigeminal neuralgia was originally operated in the traditional microscope in recent years, with the development of endoscopic technology, endoscopic surgical field in the Department of Neurosurgery The applications continue to expand, to carry out a simple neural endoscopic primary microvascular decompression for trigeminal neuralgia due to its minimally invasive, clear vision etc. many advantages and has gradually become the mainstream. The purpose of the current study, endoscopic technology has become an important part of minimally invasive Department of Neurosurgery, along with the development and improvement of surgical technique equipment. Its application gradually expanded. In this study, a comparative analysis of the relevant data of endoscopic microvascular decompression under microscope and traditional microvascular decompression in the treatment of primary trigeminal neuralgia, investigate and evaluate the single pure endoscopic application in the treatment of trigeminal neuralgia in the safety and superiority, to provide reliable basis for clinical selection different surgical methods in the treatment of trigeminal neuralgia in practice. During the period of December 2013 to December 2016 in the Department of Neurosurgery of Qilu Hospital of Shandong University, received Treatment of 162 cases of clinical data and surgical treatment of primary trigeminal neuralgia patients after follow-up results (including 67 cases underwent endoscopic microvascular decompression, 95 cases underwent traditional microscope microvascular decompression) were retrospectively analyzed. Analyzed and compared separately using related indexes of endoscopic surgery and traditional surgery under microscope. Compared in the visual field of surgical incision and surgical findings, the general data of patients, the average operation time, average bleeding volume, average hospitalization time after the operation of the difference; relief of postoperative pain; intraoperative other central nerve injury, appear facial numbness, facial paralysis, hearing loss, cerebrospinal fluid leakage, infection etc. The incidence of complications and pain recurrence were statistically analyzed, and the pain recurrence Kaplan-Meier analysis. Compared to the measurement data of t test. Method, compared by the chi square test count data, prevent the recurrence of Kaplan-Meier function analysis, standard test to P0.05 that there was statistically significant difference. The main results of the 171 patients included in the study of primary trigeminal neuralgia patients, the follow-up to 162, follow-up rate of 94.74%. follow-up to patients received simple nerve endoscopic surgery has 67 people, for the traditional microscope operation in 95 cases. Endoscopic group 65 complete remission, 2 partial remission, complete surgical remission rate was 97.01%; the average operation time was 70 ~ 100min, 20 ~ 85.31min; output 40ml, the average intraoperative 30.70ml; postoperative hospitalization time was 5 ~ 8D on average, 6.209d; after 2 patients had ipsilateral numbness, improved after treatment, the postoperative complication rate was 2.99%; 3 recurrence after operation, the recurrence rate of 4.48%. group 83 traditional microscope complete remission, 12 partial remission, complete surgical remission rate was 87. 37%; operation time was 85 ~ 120min, average 102.6min; intraoperative blood loss was 50 ~ 150ml, average 104.7ml; postoperative hospitalization time was 6 ~ 11d, average 8.649d; after 6 cases of patients with facial numbness, 5 cases of patients with lingual facial numbness, 2 cases of patients with tinnitus, 1 patients were treated by the dizziness. Improved after treatment, the complication rate was 14.74%; 14 recurrence after operation, there were no deaths during follow-up. The recurrence rate of 14.74%. group and endoscopic microscope group can effectively alleviate the symptoms, but relatively better endoscopic (P=0.0314), and endoscopic group in the mean operative time (P0.0001), bleeding (P0.0001) the hospitalization time, postoperative complication rate (P0.0001), (P=0.0135) and postoperative pain recurrence rate (P=0.0359) were significantly superior to microscopy group, the difference was statistically significant. Conclusions and suggestions of endoscopic microvascular decompression with traditional microvascular decompression under microscope The surgical treatment of primary trigeminal neuralgia surgery had a good effect, satisfactory curative effect, high safety, but the simple endoscopic microvascular decompression in the average operation time, bleeding volume, postoperative hospitalization time, complications more than microscopic surgery, endoscopic microvascular decompression is better treatment of primary trigeminal neuralgia, further promotion to the clinical significance. At the same time, the simple operation of endoscopic surgery on the operator's skill and experience have higher requirements, should be expanded to further strengthen the learning and training of primary endoscopic microvascular decompression for trigeminal neuralgia.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.3

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