本文關(guān)鍵詞： CT三維重建 C型臂 卵圓孔 療效 并發(fā)癥　出處：《承德醫(yī)學(xué)院》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探究三叉神經(jīng)射頻熱凝術(shù)在CT三維重建后Hartel穿刺路徑角度下與在C型臂引導(dǎo)下的臨床療效、術(shù)中穿刺情況及并發(fā)癥。通過比較兩種不同引導(dǎo)方式的手術(shù)臨床療效及安全性,從而找到更合適的手術(shù)引導(dǎo)方式并建立卵圓孔外口在Hartel穿刺路徑下的數(shù)據(jù)。方法:選取2015年3月至2016年3月就診于首都醫(yī)科大學(xué)宣武醫(yī)院疼痛科的40例原發(fā)性三叉神經(jīng)痛患者,患者術(shù)前行頭顱核磁共振(MRI)檢查排除占位性病變。告知相關(guān)風(fēng)險后,患者自愿行介入治療并簽屬手術(shù)同意書。采用入院順序單雙號將患者分為A、B兩組,每組各20名患者。A組、B組患者分別在CT三維重建、C型臂引導(dǎo)下行三叉神經(jīng)射頻熱凝術(shù)。入室后患者取臥位,連接監(jiān)護(hù)儀給予心率(HR)、血氧飽和度(SPO2)、收縮壓(SBP)及舒張壓(DBP)連續(xù)監(jiān)測,建立靜脈輸液通路,給予阿托品0.5mg。A組患者進(jìn)行CT頭顱掃描并三維重建,旋轉(zhuǎn)重建后顱骨,通過Hartel穿刺路徑測量卵圓孔外口長短徑及觀察有無其他穿刺影響因素后設(shè)計穿刺路徑。而B組用C型臂放射卵圓孔,觀察卵圓孔位置,設(shè)計穿刺路徑。局部皮膚消毒,鋪無菌單。用1%利多卡因于下頜角3cm局麻,22G射頻針自下頜角外側(cè)3cm穿刺至同側(cè)卵圓孔。分別用CT三維重建、C型臂確定射頻針尖位于卵圓孔處,行感覺運(yùn)動測試成功復(fù)制疼痛后,行連續(xù)射頻70℃,120s,2次。拔除射頻針,穿刺點(diǎn)貼無菌敷貼。術(shù)畢觀察30min,送回病房。兩組患者均于術(shù)前(T0)時、出院時(T1)及術(shù)后1年(T2)時對患者進(jìn)行視覺模擬評分(VAS)測量,比較兩組患者術(shù)前VAS差異及術(shù)后臨床療效。統(tǒng)計術(shù)中穿刺數(shù)及術(shù)后并發(fā)癥情況。建立卵圓孔外口在Hartel穿刺路徑下的數(shù)據(jù)。結(jié)果:1、兩組患者術(shù)前視覺模擬評分(VAS)比較A組患者術(shù)前VAS評分為8.85±1.04分,B組患者術(shù)前VAS評分為8.65±1.04分,術(shù)前(T0)時兩組VAS評分無明顯統(tǒng)計學(xué)差異(P0.05)。2、兩組患者術(shù)后出院(T1)時視覺模擬評分(VAS)比較A組患者術(shù)后出院時VAS評分為1.05±0.69分,B組患者術(shù)后出院時VAS評分為1.05±0.83分,術(shù)后出院(T1)時兩組VAS評分無明顯統(tǒng)計學(xué)差異(P0.05)。3、兩組患者術(shù)后1年(T2)時視覺模擬評分(VAS)比較A組患者術(shù)后術(shù)后1年(T2)時VAS評分為1.45±1.00分,B組患者術(shù)后1年(T2)時VAS評分為1.65±1.60分,術(shù)后1年(T2)時兩組VAS評分無明顯統(tǒng)計學(xué)差異(P0.05)。4、兩組患者術(shù)中穿刺數(shù)比較A組患者術(shù)中第一針入孔率為90%,B組患者術(shù)中第一針入孔率為50%,A組患者第一針入孔率較B組患者第一針入孔率顯著提高(P0.05)。5、兩組患者術(shù)中穿刺時間的比較A組患者術(shù)中穿刺所需時間為25.8±17.27秒;B組患者術(shù)中穿刺所需時間為42.3±25.71秒;兩組術(shù)中穿刺時間有明顯統(tǒng)計學(xué)差異,A組的穿刺所需時間顯著降低(P0.05)。6、兩組患者并發(fā)癥比較A組僅出現(xiàn)2例術(shù)后頭痛。B組患者3例表現(xiàn)為術(shù)后頭痛,3例表現(xiàn)為面部腫脹,2例表現(xiàn)為咀嚼無力,1例表現(xiàn)為術(shù)后眩暈、耳鳴。B組的并發(fā)癥發(fā)生率45%明顯高于A組并發(fā)癥發(fā)病率10%(P0.05)。7、卵圓孔外口在Hartel穿刺路徑下的數(shù)據(jù)A組患者重建后的顱骨經(jīng)過旋轉(zhuǎn)后在Hartel穿刺路徑下最大限度暴露卵圓孔時,卵圓孔的長徑為5.01±2.14mm,短徑長度為3.1±2.10mm。結(jié)論:CT三維重建引導(dǎo)下行三叉神經(jīng)射頻熱凝術(shù)(RFT)與在C型臂引導(dǎo)下行三叉神經(jīng)射頻熱凝術(shù)治療原發(fā)性三叉神經(jīng)痛(classical trigeminal neuralgia,CTN)均可明顯降低疼痛程度。CT三維重建引導(dǎo)下行三叉神經(jīng)射頻熱凝術(shù)(RFT)在穿刺卵圓孔過程優(yōu)于在C型臂引導(dǎo)下行三叉神經(jīng)射頻熱凝術(shù),可以明顯降低并發(fā)癥的發(fā)生率,更為安全。
[Abstract]:Objective: To explore the trigeminal nerve radiofrequency thermocoagulation for the clinical efficacy of Hartel guided puncture path and angle in the C arm in CT reconstruction after puncture and complications during surgery. Clinical efficacy and safety by comparing two different guiding modes, so as to find a more suitable surgical guidance and the establishment of the foramen ovale outside the mouth in the Hartel puncture path of the data. Methods: from March 2015 to March 2016 in Xuanwu Hospital of Capital Medical University, the Department of pain in 40 cases of primary trigeminal neuralgia patients, preoperative cranial magnetic resonance (MRI) examination to exclude lesions. Inform the relevant risk after interventional therapy for patients with voluntary and sign the consent form. The dual number of hospital patients were divided into A, B two groups, each group of 20 patients in.A group, B group of patients were in CT reconstruction, C arm guided radio frequency thermocoagulation of trigeminal nerve After entering the room. The patient supine, connect the monitor to the heart rate (HR), oxygen saturation (SPO2), systolic blood pressure (SBP) and diastolic blood pressure (DBP) continuous monitoring, the establishment of intravenous infusion pathway, 0.5mg.A group were given atropine CT scan and three-dimensional reconstruction, reconstruction of skull after rotation, through the puncture path design Hartel measurement of foramen ovale puncture path outside diameter and observe whether other factors influence. While group B puncture with C arm radiation foramen ovale, observe the location of foramen ovale, design of puncture path. Local skin disinfection, sterile. With 1% lidocaine in local anesthesia mandibular angle 3cm, 22G RF needle from the mandibular angle 3cm puncture to the ipsilateral lateral foramen ovale. Respectively using CT 3D reconstruction, C arm to determine the RF tip is positioned in the foramen ovale, feeling pain after exercise test successfully, continuous RF 70 DEG C, 120s, 2. Removal of RF needle puncture point with sterile dressing. Postoperative view 瀵，

本文編號：1553242