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中国全科医学 ›› 2018, Vol. 21 ›› Issue (23): 2827-2832.DOI: 10.3969/j.issn.1007-9572.2017.00.195

• 专题研究 • 上一篇    下一篇

不同温度经皮半月神经节射频热凝术治疗单支三叉神经痛的疗效及预后研究

方胜春1，公维义2，芦海燕3，唐元章4，周国明1*，倪家骧4   

  1. 1.067000河北省承德市，承德医学院附属医院疼痛科　2.518101广东省深圳市宝安区人民医院麻醉科　3.100075北京市东城区第一人民医院麻醉科　4.100053北京市，首都医科大学宣武医院疼痛科
    *通信作者：周国明，主任医师；E-mail：zgm59@126.com
  • 出版日期:2018-08-15 发布日期:2018-08-15

Effects and Clinical Outcomes of Percutaneous Radiofrequency Thermocoagulation of the Gasserian Ganglion at Different Temperatures for Single Branch of Trigeminal Neuralgia　

FANG Sheng-chun1，GONG Wei-yi2，LU Hai-yan3，TANG Yuan-zhang4，ZHOU Guo-ming1*，NI Jia-xiang4   

  1. 1.Department of Pain Management，Affiliated Hospital of Chengde Medical University，Chengde 067000，China
    2.Department of Anesthesiology，Shenzhen Baoan People's Hospital，Shenzhen 518101，China
    3.Department of Anesthesiology，First People's Hospital of Beijing Dongcheng District，Beijing 100075，China
    4.Department of Pain Management，Xuanwu Hospital，Capital Medical University，Beijing 100053，China
    *Corresponding author：ZHOU Guo-ming，Chief physician；E-mail：zgm59@126.com
  • Published:2018-08-15 Online:2018-08-15

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摘要： 目的　探讨不同温度经皮半月神经节射频热凝术（RFT）治疗不同分支单支三叉神经痛的疗效和预后。方法　回顾性分析2003—2011年首都医科大学宣武医院疼痛科行经皮半月神经节RFT治疗的单支三叉神经痛患者550例，其中V1分支（眼支）38例，V2分支（上颌支）257例，V3分支（下颌支）255例。根据温度分为70、75、80 ℃组，分析其治疗有效率、1~5年复发率和面部麻木程度。结果　V1分支三叉神经痛70、75、80 ℃组患者治疗有效率分别为10/10、18/20、7/8，差异无统计学意义（χ2=1.212，P=0.545）；V2分支三叉神经痛70、75、80 ℃组患者治疗有效率分别为93.1%（54/58）、94.4%（167/177）、100.0%（22/22），差异无统计学意义（χ2=1.518，P=0.468）；V3分支三叉神经痛70、75、80 ℃组患者治疗有效率分别为87.7%（50/57）、94.8%（165/174）、95.8%（23/24），差异无统计学意义（χ2=3.753，P=0.153）。V1、V2分支三叉神经痛不同温度治疗组患者1~5年复发率比较，差异均无统计学意义（P>0.05）；V3分支三叉神经痛不同温度治疗组患者1~5年复发率比较，差异均有统计学意义（P<0.05）；其中75、80 ℃组患者1~5年复发率低于70 ℃组（P<0.01）。V1分支三叉神经痛不同温度治疗组患者面部麻木程度比较，差异无统计学意义（P>0.05）；V2、V3分支三叉神经痛不同温度治疗组患者面部麻木程度比较，差异均有统计学意义（P<0.05）；其中V2、V3分支三叉神经痛75、80 ℃组患者面部麻木程度高于70 ℃组（P<0.01）。仅1例V1分支三叉神经痛患者80 ℃治疗后出现角膜溃疡，经对症治疗后好转。结论　70 ℃经皮半月神经节RFT适用于V1、V2分支三叉神经痛，而75 ℃适用于V3分支。

关键词: 三叉神经痛, 射频热凝术, 温度, 疼痛, 麻木

Abstract: Objective　To investigate the effects and clinical outcomes of percutaneous radiofrequency thermocoagulation（RFT） of the gasserian ganglion at different temperatures for patients with single V1，V2 or V3 branch of the trigeminal neuralgia（TN）．Methods　In this study，the sample consists of a total of 550 patients with single branch of TN treated by percutaneous RFT at different temperatures（including 70 ℃ group，75 ℃ group，and 80 ℃ group） in Department of Pain Management，Xuanwu Hospital，Capital Medical University，during 2003 to 2011，of them，the number of patients suffered from single V1，V2 or V3 TN was 38，257 and 255 respectively.The therapeutic efficiency，1-5 year recurrence rate，and facial numbness were evaluated after treatment.Results　The therapeutic efficiency rate of percutaneous RFT at 70℃，75℃，80 ℃ were 10/10，18/20，7/8，respectively，for patients with V1 TN（χ2=1.212，P=0.545），93.1%（54/58），94.4%（167/177），100.0%（22/22），respectively for patients with V2 TN（χ2=1.518，P=0.468），and 87.7%（50/57），94.8%（165/174），95.8%（23/24），respectively，for patients with V3 TN（χ2=3.753，P=0.153），which indicated that the effects of this therapy for V1，V2 or V3 TN were not affected significantly by temperature.The 1-5 year recurrence rate did not differ significantly in patients with V1 TN treated by percutaneous RFT at different temperatures（P>0.05）．And a similar thing was observed in those with V2 TN treated by percutaneous RFT at different temperatures（P>0.05）．However，there was a significant difference in 1-5 year recurrence rate in patients with V3 TN，it was significant lower in 75 ℃ and 80 ℃ groups when compared with 70 ℃ group（P<0.01）．The distribution of facial numbness intensity did not differ significantly in patients with V1 TN treated by percutaneous RFT at different temperatures（P>0.05），but it differed obviously in those with V2 TN or V3 TN（P<0.05）．Specifically，in patients with V2 TN treated by percutaneous RFT，the improvement in facial numbness in those treated at 70 ℃ was better than that of those treated at 75 ℃ and 80 ℃（P<0.01）．Likewise，in patients with V3 TN treated by percutaneous RFT，those treated at 70 ℃ had greater improvement in facial numbness than those treated at 75 ℃ and 80 ℃（P<0.01）．Only one patient with V1 TN treated using RFT at 80 ℃ suffered from corneal ulcer，but was improved after symptomatic treatment.Conclusion　Percutaneous RFT of the gasserian ganglion at 70 ℃ is appropriate for patients with V1 and V2 TN，and percutaneous RFT at 75 ℃ is appropriate for patients with V3 TN.

Key words: Trigeminal neuralgia, Radiofrequency thermocoagulation, Temperature, Pain, Numbness

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