经侧方入路与经卵圆孔三叉神经下颌支介入射频热凝术及临床比较

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1、经侧方入路与经卵圆孔三叉神经下颌支介入射频热凝术的临床比较廖翔蒋劲熊东林张强肖礼祖郑虎山梁豪文罗裕辉(深圳市第六人民医院疼痛科，深圳518052)摘要目的:对经侧方入路与经卵圆孔神经射频热凝术治疗原发性三叉神经下颌支顽固性疼痛进行临床比较。方法:2003年6月～2007年6月，68例原发性三叉神经下颌支顽固性疼痛患者被纳入，随机分成两组，分别在DSA介导下进行经侧方入路或经卵圆孔三叉神经下颌支射频热凝术。利用视觉模拟评分法(VAS)进行各自术前与术后不同时段疗效评定。利用Kaplan-Meier生存曲线与Log-Rank检验比较两组术后疗效，同时记录

2、手术副作用、并发症发生情况及复发率，进行统计比较。结果:术后两组VAS评分均明显下降，术前术后比较差异有统计学意义(P＜0．05)。两组患者术后疗效组间比较，差异无统计学意义(P＞0．05)。副作用方面，两组患者术后均有一定程度的下颌支支配区域皮肤麻木，舌体侧方麻木，味觉减退，伸下颌协调性下降。并发症方面，经侧方入路组的患者术后没有严重并发症以及主观不适，经卵圆孔组出现3例神经损伤。发生率高于经侧方入路组(P＜0．05)。两组术后复发率无显著差异。结论:经侧方入路与经卵圆孔下颌神经射频热凝术相比，两者均有定位确切、操作方便的特点，均有优良的临床疗效，

3、但前者的手术并发症少于后者。关键词射频热凝;下颌神经;卵圆孔;三叉神经痛CLINICALCOMPARISONOFRADIOFREQUENCYTHERMOCOAGULATIONTREAT-MENTOFMANDIBULARNERVEVIALATERALAPPROACHORTHROUGHFORAMENOVALEINPATIENTSWITHPRIMARYTRIGEMINALNEURALGIALIAOXiang，JIANGJing，XIONGDong-Lin，ZHANGQiang，XIAOLizu，ZHENGHu-Shan，LIANG，Hao-Wen，LUOY

4、u-Hui(DepartmentofPainMedicine，ShenzhenSixthPeople＇sHospital，Shenzhen518052)AbstractObjective:Tocomparetheeffectivenessofradiofrequencythermocoagulationtreatmentofmandibularnervevialateralapproachandviaforamenovaleinpatientswithprimarytrigeminalneuralgia(TN)．Methods:FromJune200

5、3toJune2007，68patientswithintractableTNwereenrolledandran-domlydividedintotwogroups．UndertheguidanceofDSA，groupAweretreatedwithradiofrequencythermocoagulationvialateralapproachwhilegroupBunderwentradiofrequencythermocoagulationviafo-ramenovale．Aftertheoperation，theefficacyinclu

6、dingVAS，sideeffectsandcomplicationsofthesur-geryfrombothgroupswererecordedtillthe36thmonthandanalyzedforcomparison．Results:BothgroupsshowedsignificantdecreaseofVASaftertheoperation(P＜0．05)．Therearenoobviousdifferencesbetweenthetwogroupsintermsofclinicaleffects，butgroupAhadlessc

7、omplicationscomparedtogroupB．Conclusion:Radiofrequencythermocoagulationtreatmentofmandibularnervevialateralap-proachandviaforamenovalehaveagoodlongtermeffect．Comparedtooperationviaforamenovale，thelateralapproachhaslesscomplications．KeywordsRadiofrequencythermocoagulation;Mandib

8、ularnerve;Foramenovale;Trigeminalneuralgia三叉神经痛是疼痛科、神经