發(fā)布時(shí)間：2018-04-13 17:33

  本文選題：多根顱神經(jīng)異常興奮綜合征 + 危險(xiǎn)因素��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究目的:通常將血管壓迫顱神經(jīng)入腦干區(qū)而引起的病理過(guò)程稱之為顱神經(jīng)異常興奮綜合征(Hyperactive dysfunction syndrome,HDS),包括原發(fā)性三叉神經(jīng)痛(Trigeminal neuralgia,TN)、特發(fā)性偏側(cè)面肌痙攣(Hemifacial spasm,HFS)、舌咽神經(jīng)痛(Glossopharyngeal neuralgia,GPN)。而多根顱神經(jīng)異常興奮綜合征(Combined HDS)則為兩根或兩根以上的顱神經(jīng)入腦干區(qū)受血管壓迫造成的多發(fā)性顱神經(jīng)病變,其既可發(fā)生在單側(cè),亦可發(fā)生在雙側(cè)。既可同時(shí)起病,亦可先后起病。本文旨在對(duì)齊魯醫(yī)院神經(jīng)外科行微血管減壓術(shù)治療的44例多根顱神經(jīng)異常興奮綜合征進(jìn)行回顧性研究,以深化對(duì)該綜合征相關(guān)臨床特點(diǎn)及治療的進(jìn)一步認(rèn)識(shí)。研究背景:臨床上,多根顱神經(jīng)異常興奮綜合征比較少見,目前對(duì)該綜合征的臨床特點(diǎn)缺乏系統(tǒng)性的研究及足夠的了解,通過(guò)深化對(duì)多根顱神經(jīng)異常興奮綜合征的研究,可進(jìn)一步加強(qiáng)對(duì)該綜合征的認(rèn)識(shí),并指導(dǎo)相關(guān)臨床診斷與治療。研究方法:收集山東大學(xué)齊魯醫(yī)院腦外科2006年11月至2016年9月行微血管減壓術(shù)后的顱神經(jīng)異常興奮綜合征1450例,包括單純?cè)l(fā)性三叉神經(jīng)痛1030例,單純特發(fā)性面肌痙攣310例,單純舌咽神經(jīng)痛66例,兩根或兩根以上的顱神經(jīng)疾患44例。收集所有病歷中的相關(guān)臨床及影像學(xué)資料,包括病史,臨床表現(xiàn),既往史,術(shù)前磁共振(MRI),術(shù)中觀察,術(shù)后表現(xiàn)及術(shù)后并發(fā)癥等,進(jìn)行整理分析,總結(jié)多根顱神經(jīng)異常興奮綜合征的臨床特點(diǎn)。并通過(guò)對(duì)多根組與單根組患者在年齡、性別、血壓水平、血脂水平、血糖水平、術(shù)后并發(fā)癥的發(fā)生情況等方面的比較,得出兩組間是否存在差異。研究結(jié)果:在本研究中的所有行微血管減壓手術(shù)治療的1450例顱神經(jīng)異常興奮綜合征患者中,多根顱神經(jīng)異常興奮綜合征共44例,占總數(shù)的3.03%,包括單側(cè) TN-HFS 14 例,單側(cè) TN-GPN 26 例,雙側(cè) TN 2 例,單側(cè) TN-HFS-GPN 2 例。多根顱神經(jīng)異常興奮綜合征組中,女性39例,男性5例,相對(duì)于單根顱神經(jīng)異常興奮綜合征,更好發(fā)于女性,且有統(tǒng)計(jì)學(xué)差異[88.6%(39/44)vs.66.9%(940/1406),p=0.002]。多根顱神經(jīng)異常興奮綜合征組平均年齡60.9歲,單根顱神經(jīng)異常興奮綜合征組平均年齡53.5歲,p=0.035,具有統(tǒng)計(jì)學(xué)差異。多根顱神經(jīng)異常興奮綜合征組中,高血壓發(fā)病率明顯高于單根顱神經(jīng)異常興奮綜合征組[40.9%(18/44)vs.23.8%(335/1406),p=0.009]。多根顱神經(jīng)異常興奮綜合征組中,三叉神經(jīng)、面神經(jīng)、舌咽神經(jīng)的最常見責(zé)任血管分別是小腦上動(dòng)脈(21/44)、小腦前下動(dòng)脈(7/16)、小腦后下動(dòng)脈(12/28)。且相關(guān)顱神經(jīng)責(zé)任血管的發(fā)生率較之單根顱神經(jīng)異常興奮綜合征組的差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。44例多根顱神經(jīng)異常興奮綜合征患者全部行經(jīng)乙狀竇后開顱微血管減壓術(shù),總治愈率97.7%(43/44)。隨訪時(shí)間6～80個(gè)月,平均40.3個(gè)月。共有3例三叉神經(jīng)痛復(fù)發(fā),復(fù)發(fā)率3.33%。多根顱神經(jīng)異常興奮綜合征組術(shù)后某些并發(fā)癥的發(fā)生率明顯高于單根顱神經(jīng)異常興奮綜合征組,包括心功能不全[6.81%(3/44)vs.1.78%(25/1406),p=0.050],呼吸系統(tǒng)感染[6.81%(3/44)vs.1.35%(19/1406),p=0.027],下肢深靜脈血栓形成[4.55%(2/44)vs.0.57%(8/1406),p=0.035],術(shù)后譫妄[27.2%(12/44)vs.14.9%(209/1406),p=0.024]。結(jié)論:臨床上多根顱神經(jīng)異常興奮綜合征相對(duì)少見,好發(fā)于老年女性。其中,原發(fā)性三叉神經(jīng)痛合并舌咽神經(jīng)痛是該綜合征較為常見的類型。鑒于該綜合征好發(fā)于老年患者,術(shù)后心功能障礙、肺部感染、下肢靜脈血栓、一過(guò)性認(rèn)知功能障礙等并發(fā)癥相對(duì)多見,應(yīng)該引起足夠的關(guān)注。顯微血管減壓術(shù)是目前應(yīng)首選的有效治療方法。
[Abstract]:Objective: To study the vascular compression of cranial nerve usually into the brainstem and pathological process caused by the called cranial nerve excited syndrome (Hyperactive dysfunction, syndrome, HDS), including primary trigeminal neuralgia (Trigeminal neuralgia, TN), idiopathic hemifacial spasm (Hemifacial spasm, HFS), glossopharyngeus neuralgia (Glossopharyngeal neuralgia, GPN). The multiple cranial nerve excited syndrome (Combined HDS) for two or more cranial nerve into the brainstem vascular compression caused by multiple cranial neuropathy, which may occur in both unilateral and bilateral. It also occurs in both disease at the same time, also has this paper aims at the onset. 44 cases of cranial nerves in the Department of Neurosurgery of Qilu Hospital underwent microvascular decompression for the treatment of excited syndrome were retrospectively studied, so as to deepen the further understanding of the syndrome related to the clinical characteristics and treatment General background: clinically, multiple cranial nerve excited syndrome is rare, the clinical features of the syndrome is lack of systematic study and sufficient understanding, through the study of deepening excited for multiple cranial nerve syndrome, can further enhance the understanding of the syndrome, and related clinical guidance the diagnosis and treatment. Methods: collected the cranial nerve Department of cerebral surgery of Qilu Hospital of Shandong University from November 2006 to September 2016 after undergoing microvascular decompression of the excited syndrome in 1450 cases, including simple primary trigeminal neuralgia in 1030 cases with idiopathic hemifacial spasm in 310 cases, simple glossopharyngeal neuralgia 66 cases, two or more than two cranial nerve diseases 44. Collect all medical records of the clinical and imaging data, including medical history, clinical symptoms, medical history, preoperative magnetic resonance (MRI), intraoperative, postoperative appearance and postoperative complications, By analyzing the clinical features of multiple cranial nerve excited syndrome. According to a plurality of groups and single groups in age, gender, level of blood pressure, blood lipids, blood glucose levels, and other aspects of the occurrence of postoperative complications between the two groups that whether there exist differences. Results: 1450 patients all cases of cranial nerve in the study of the microvascular decompression surgery excited syndrome, multiple cranial nerve excited syndrome 44 cases, accounting for 3.03% of the total, including 14 patients with unilateral TN-HFS, unilateral TN-GPN in 26 cases, 2 cases of double side TN, 2 cases of unilateral TN-HFS-GPN. Multiple cranial nerve abnormalities excited syndrome group, 39 cases were female, 5 male patients, compared with the single cranial nerve excited syndrome is more common in women, and there were significant differences in [88.6% (39/44) vs.66.9% (940/1406) p=0.002]., a plurality of cranial nerve excited synthesis Patients with an average age of 60.9 years, a single cranial nerve excited syndrome group, the average age of 53.5 years, p=0.035, with statistical difference. A plurality of cranial nerve excited syndrome group, the incidence of hypertension was significantly higher than that of single cranial nerve excited syndrome group [40.9% (18/44) vs.23.8% (335/1406), p=0.009]. of cranial nerve very excited syndrome group, trigeminal nerve, facial nerve, the most common blood vessel of the glossopharyngeal nerve were the superior cerebellar artery (21/44), anterior inferior cerebellar artery (7/16), posterior inferior cerebellar artery (12/28). And the incidence of cranial nerve vascular than single cranial nerve excited syndrome between groups no statistical significance (P0.05).44 cases of multiple cranial nerve excited syndrome patients underwent retrosigmoid craniotomy microvascular decompression, the total cure rate was 97.7% (43/44). The follow-up time was 6~80 months, with an average of 40.3 months. A total of 3 cases The recurrence rate of recurrent trigeminal neuralgia, 3.33%. cranial nerves excited syndrome group after some complication rate was significantly higher than that of single cranial nerve excited syndrome group, including heart failure [6.81% (3/44) vs.1.78% (25/1406), p=0.050], [6.81% infection of the respiratory system (3/44), p=0.027] vs.1.35% (19/1406). Deep venous thrombosis of lower extremity [4.55% (2/44) vs.0.57% (8/1406, p=0.035]), postoperative delirium (12/44) [27.2% vs.14.9% (209/1406) p=0.024].. Conclusion: the clinical syndrome of cranial nerves excited relatively rare, occurs in older women. Among them, the primary trigeminal neuralgia and glossopharyngeal neuralgia is the the most common types of syndrome. The syndrome occurs in elderly patients with cardiac dysfunction, postoperative pulmonary infection, venous thrombosis, transient cognitive dysfunction and other complications are more common, should arouse enough attention.. Microvascular decompression is the first choice for effective treatment.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.3

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本文編號(hào)：1745519