目的 比较立体定向射频热凝术与立体定向放射技术(伽玛刀)治疗原发性三叉神经痛的疗效。方法 回顾性分析2014-01至2016-01收治的46例原发性三叉神经痛患者临床资料,其中立体定向射频热凝术21例(射频组),伽玛刀治疗25例(伽玛刀组)。对比两组治疗后疼痛控制率、并发症和复发情况,评定疗效。结果 46例随访时间12～36个月,平均25.6个月。根据巴罗(BNI)疼痛量表评定,射频组术后Ⅰ级17例(81.0%),Ⅱ级2例(9.5%),Ⅲ级1例(4.8%),Ⅳ～Ⅴ级1例(4.8%),有效Ⅰ～Ⅲ级20例(95.2%);伽玛刀组术后Ⅰ级12例(48.0%),Ⅱ级4例(16.0%),Ⅲ级6例(24.0%),Ⅳ～Ⅴ级3例(12.0%),有效Ⅰ～Ⅲ级22例(88.0%)。术后两组比较,射频组Ⅰ级优于伽玛刀治疗组,差异有统计学意义(P＜0.05),Ⅱ、Ⅲ级及有效率差异无统计学意义。术后射频组面部麻木发生率(81.0%)明显高于伽玛刀组(9.5%),咀嚼肌力下降、口角流涎、角膜炎发生率等两组对比,差异无统计学意义。射频组、伽玛刀组复发各1例。结论 射频热凝和伽玛刀治疗三叉神经痛疗效肯定,射频治疗起效快,恢复优良率高,但有一定的侵袭性和并发症;伽玛刀治疗无创,并发症少且轻,相对更安全,缺点是起效较慢。
Abstract
Objective To compare the therapeutic efficacy of stereotactic radiofrequency thermocoagulation(RF) and Gamma knife radiosurgery (GKS) for the treatment of trigeminal neuralgia(TN).Methods The treatment outcomes of 46 patients with TN were analyzed retrospectively. 21 of them underwent RF treatment and the rest underwent GKS treatment. The pain control rate,complications and recurrence were used to assess the therapeutic effect.Results The mean follow-up time was 25.6 months (ranged from 12 to 36 months).According to barrow neurological institute (BNI) pain scale, RF group had 17 cases of grade Ⅰ,2 cases of grade Ⅱ,1 case of grade Ⅲ, and 1 case of Ⅳ-Ⅴ. 20 cases of grade I to III were effective. In the GKS group, there were 12 cases of grade Ⅰ,4 cases of of grade Ⅱ,6 cases of grade Ⅲ, and 3 cases of Ⅳ-Ⅴ, so 22 cases were effectively treated. There were more cases of grade Ⅰ in the RF group than in the GKS group, and the difference was statistically significant. The effective rate was not statistically significant between grade II and grade III. The incidence of facial numbness in the RF group was significantly higher than that of the GKS group, but there was no statistically significant difference in the decline of masticatory muscle strength, angular salivation or keratitis. One case of recurrences was seen in both groups.Conclusions Both RF and GSK can obviously relieve pain in TN patients. RF treatment has quick effect and brings about quick recovery but it can induce complications. GKS treatment is non-invasive and safe, with fewer complications , but is slow to produce effect.
关键词
三叉神经痛 /
射频热凝术 /
立体定向放射外科
Key words
trigeminal neuralgia /
radiofrequency thermocoagulation /
Gamma knife radiosurgery
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