半月神经节射频热凝治疗不同程度血管关联性三叉神经痛的效果分析

郭燕; 王立奎; 朱本藩; 毛煜

doi:10.16766/j.cnki.issn.1674-4152.002486

半月神经节射频热凝治疗不同程度血管关联性三叉神经痛的效果分析

doi: 10.16766/j.cnki.issn.1674-4152.002486

安徽医科大学第一附属医院疼痛科，安徽合肥 230022

基金项目:

国家自然科学基金项目 82101301

详细信息

通讯作者:
毛煜, E-mail: yumao@mail.ustc.edu.cn

中图分类号: R745.11R741.05
计量
- 文章访问数: 196
- HTML全文浏览量: 73
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2021-11-30
- 网络出版日期: 2022-09-21

Effect of radiofrequency thermocoagulation on semilunar ganglion in treating different degrees of vascular associated trigeminal neuralgia

Department of Pain Medicine, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, China

摘要

摘要: 目的观察三叉神经射频热凝治疗不同程度血管关联性三叉神经痛的临床疗效。方法采用回顾性分析纳入2015年9月—2020年11月安徽医科大学第一附属医院101例三叉神经痛患者，包括32例三叉神经与周围血管无关联患者(A组)，40例三叉神经与周围血管密切相关患者(B组)和29例血管压迫三叉神经患者(C组)。3组均行CT引导半月神经节射频热凝术，观察并比较3组术前及术后1、3、6、12个月的VAS评分、生活质量、卡马西平使用剂量、治疗优良率。结果 3组患者VAS评分比较差异有统计学意义，组间及组内不同时间点两两比较差异有统计学意义(F_{组间/时间/交互}=125.402, 261.255, 20.994；均P < 0.05);3组患者卡马西平使用剂量比较差异有统计学意义，组间及组内不同时间点两两比较差异有统计学意义(F_{组间/时间/交互}=126.065, 266.616, 15.125；均P < 0.05)。A组VAS评分和卡马西平使用剂量低于B组、C组(均P＜0.05)，B组与C组比较差异无统计学意义(均P>0.05)。3组患者手术后VAS评分、卡马西平使用剂量较手术前均明显下降(均P＜0.05)。3组患者手术后生活质量明显升高(均P＜0.05)。3组患者术后12个月治疗优良率分别为90.63%、82.50%、86.21%。结论 CT引导半月神经节射频热凝术治疗三叉神经痛可明显缓解疼痛，提高患者生活质量，血管神经关联影响手术效果。
- 三叉神经痛 /
- 磁共振神经成像 /
- 射频热凝
Abstract: Objective To observe the clinical efficacy of trigeminal nerve radiofrequency thermocoagulation in the treatment of different degrees of vascular associated trigeminal neuralgia. Methods A total of 101 patients with trigeminal neuralgia from September 2015 to November 2020 in the First Affiliated Hospital of Anhui Medical University were enrolled in the retrospective analysis, including 32 patients with no trigeminal nerve associated with peripheral blood vessels (group A), 40 patients with the trigeminal nerve closely related to peripheral vascular (group B) and 29 patients with vascular compression of trigeminal nerve (group C). Radiofrequency thermocoagulation of the semilunar ganglion guided by CT was performed in all three groups. Visual analogue scale (VAS), quality of life, carbamazepine dose and excellent and good rate of treatment were observed and compared before and after 1, 3, 6 and 12 months in the three groups. Results There were statistically significant differences in VAS scores among the 3 groups, and there were statistically significant differences between groups and at different time points within groups (F_{intergroup/time/interaction}=125.402, 261.255, 20.994; all P < 0.05). There were statistically significant differences in the dose of carbamazepine among the 3 groups, and statistically significant differences between groups and at different time points within groups (F_{intergroup/time/interaction}=126.065, 266.616, 15.125; all P < 0.05). VAS score and carbamazepine dose in group A were lower than those in group B and group C (all P < 0.05), and there was no statistical significance between group B and group C (all P>0.05). VAS score and carbamazepine dose in three groups were significantly decreased after operation compared with before operation (all P < 0.05). The quality of life of patients in the three groups was significantly improved after surgery (all P < 0.05). The excellent and good rates of the three groups after 12 months were 90.63%, 82.5% and 86.21%, respectively. Conclusion CT-guided radiofrequency thermocoagulation on semilunar ganglion can significantly relieve pain and improve the quality of life of patients with trigeminal neuralgia. Vascular nerve association affects the outcome of surgery.
- Trigeminal neuralgia /
- Magnetic resonance neurography /
- Radiofrequency thermocoagulation

HTML全文

图 1 三叉神经MRI中三叉神经与周围血管不同毗邻状态

注：A为三叉神经走行，周围无相关血管；B为三叉神经与血管密切相关；C为血管压迫三叉神经；箭头示三叉神经，三角形示血管。

Figure 1. Different adjacent states of trigeminal nerve and peripheral blood vessels in MRI of trigeminal nerve

下载: 全尺寸图片幻灯片

表 1 3组三叉神经痛患者一般资料比较

Table 1. General data of patients with trigeminal neuralgia in three groups

组别	例数	年龄(x±s，岁)	VAS (x±s，分)	性别[例(%)]		病程(x±s，年)	受累分支[例(%)]
组别	例数	年龄(x±s，岁)	VAS (x±s，分)	男性	女性	病程(x±s，年)	Ⅱ	Ⅲ	Ⅱ、Ⅲ
A组	32	64.78±12.33	7.22±1.31	14(43.75)	18(56.25)	5.51±2.91	16(50.00)	8(25.00)	8(25.00)
B组	40	65.33±11.55	7.30±1.44	18(45.00)	22(55.00)	5.47±2.03	22(55.00)	10(25.00)	8(20.00)
C组	29	64.76±10.83	7.45±1.38	10(34.48)	19(65.52)	5.32±2.86	16(55.17)	5(17.24)	8(27.59)
统计量		0.028^a	0.217^a	0.856^b		1.123^a	1.089^b
P值		0.973	0.806	0.652		0.329	0.896
注：^a为F值，^b为χ²值。

下载: 导出CSV

表 2 3组三叉神经痛患者不同时间点VAS评分比较(x±s，分)

Table 2. Comparison of VAS scores at different time points among three groups of patients with trigeminal neuralgia (x±s, points)

组别	例数	术前	术后1个月	术后3个月	术后6个月	术后12个月	F值	P值
A组	32	7.22±1.31	1.88±0.98^a	2.03±0.69^a	2.18±0.59^a	2.16±0.88^a	198.820	＜0.001
B组	40	7.30±1.44	3.03±1.07^ab	3.08±0.70^ab	3.18±0.93^ab	3.50±1.30^ab	104.109	＜0.001
C组	29	7.45±1.38	2.79±1.21^ab	2.90±0.72^ab	2.86±0.83^ab	3.10±1.05^ab	157.007	＜0.001
F值		0.217	14.565	21.426	25.326	18.362
P值		0.806	＜0.001	＜0.001	＜0.001	＜0.001
注：与同组术前比较，^aP＜0.05;与A组比较，^bP＜0.05。

下载: 导出CSV

表 3 3组三叉神经痛患者口服卡马西平量比较(x±s，g/周)

Table 3. Comparison of carbamazepine dose in three groups of patients with trigeminal neuralgia (x±s, g/week)

组别	例数	术前	术后1个月	术后3个月	术后6个月	术后12个月	F值	P值
A组	32	4.31±1.18	1.31±0.66^a	1.33±0.72^a	1.38±0.86^a	1.42±0.97^a	69.221	＜0.001
B组	40	4.73±1.00	1.82±0.95^ab	2.14±0.76^ab	2.43±0.73^ab	2.61±0.65^ab	76.759	＜0.001
C组	29	4.08±1.11	2.33±0.68^ab	2.35±0.75^ab	2.38±0.83^ab	2.40±0.89^ab	126.529	＜0.001
F值		3.138	22.507	45.389	59.772	24.877
P值		0.058	＜0.001	＜0.001	＜0.001	＜0.001
注：与同组术前比较，^aP＜0.05;与A组比较，^bP＜0.05。

下载: 导出CSV

表 4 3组三叉神经痛患者治疗前后生活质量评分比较(x±s，分)

Table 4. Comparison of quality of life scores in three groups of patients with trigeminal neuralgia before and after treatment (x±s, points)

组别	例数	生理职能		精神健康		社会功能		情感功能
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
A组	32	60.88±3.55	77.25±2.85^a	64.56±3.06	80.56±4.37^a	61.88±2.32	78.38±3.12^a	61.44±2.05	78.72±2.33^a
B组	40	60.88±3.55	70.93±3.25^ab	65.53±3.39	73.95±4.39^ab	62.53±2.74	72.00±3.82^ab	61.50±2.26	70.60±2.55^ab
C组	29	60.72±2.53	71.79±3.12^ab	64.79±3.52	70.48±4.36^ab	62.45±2.20	70.79±3.35^ab	62.28±2.83	70.62±2.48^ab
F值		0.044	128.067	0.856	105.244	0.696	139.347	1.188	138.407
P值		0.957	＜0.001	0.428	＜0.001	0.501	＜0.001	0.309	＜0.001

组别	例数	躯体疼痛		生命活力		总体健康		生活功能
组别	例数	术前	术后	术前	术后	术前	术后	术前	术后
A组	32	62.63±3.58	79.97±3.73^a	62.19±3.35	78.84±2.69^a	61.75±6.55	80.47±2.92^a	63.03±3.61	79.47±2.92^a
B组	40	62.08±4.02	71.23±3.18^ab	62.55±3.71	71.38±4.59^ab	62.23±4.84	72.68±3.96^ab	63.95±3.92	71.13±4.34^ab
C组	29	62.59±3.61	70.79±2.51^ab	62.69±3.13	70.10±1.63^ab	62.10±1.88	71.00±4.27^ab	64.45±4.34	71.10±5.39^ab
F值		0.241	111.703	0.178	104.697	0.087	136.613	1.023	148.651
P值		0.786	＜0.001	0.837	＜0.001	0.916	＜0.001	0.363	＜0.001
注：与同组术前比较，^aP＜0.05;与A组比较，^bP＜0.05。

下载: 导出CSV

表 5 3组三叉神经痛患者术后6个月及12个月手术治疗优良率比较[例(%)]

Table 5. Comparison of excellent and good rates of surgical treatment in patients with trigeminal neuralgia in three groups at 6 and 12 months after operation [cases (%)]

组别	例数	术后6个月	术后12个月
A组	32	29(90.63)	29(90.63)
B组	40	35(87.50)	33(82.50)
C组	29	26(89.66)	25(86.21)
χ²值		0.191	0.983
P值		0.909	0.612

下载: 导出CSV

参考文献(16)

[1]	ZENG F, ZHU M Y, WAN Q, et al. The treatment of V2+V3 idiopathic trigeminal neuralgia using peripheral nerve radiofrequency thermocoagulation via the foramen rotundum and foramen ovale compared with semilunar ganglion radiofrequency thermocoagulation[J]. Clin Neurol Neurosurg, 2020. DOI: 10.1016/j.clineuro.2020.106025.
[2]	赵素倩, 穆楠楠, 马树泽, 等. 3D打印导板辅助卵圆孔定位射频热凝术中不同热凝时间治疗三叉神经痛的效果及安全性[J]. 局解手术学杂志, 2021, 30(6): 529-535. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ202106016.htm ZHAO S Q, MU N N, MA S Z, et al. Effect and safety of different thermocoagulation time in radiofrequency thermocoagulation for the treatment of trigeminal neuralgia[J]. Journal of Regional Anatomy and Operative Surgery, 2021, 30(6): 529-535. https://www.cnki.com.cn/Article/CJFDTOTAL-JJXZ202106016.htm
[3]	DING Y Y, YAO P, LI H X, et al. Comparison of efficacy and safety of ct-guided radiofrequency thermocoagulation through foramen rotundum versus foramen ovale for V2 primary trigeminal neuralgia[J]. Pain Physician, 2021, 24(8): 587-596.
[4]	STERMAN-NETO H, FUKUDA C Y, DUARTE K P, et al. Balloon compression vs radiofrequency for primary trigeminal neuralgia: A randomized, controlled trial[J]. Pain, 2021, 162(3): 919-929. doi: 10.1097/j.pain.0000000000002070
[5]	陈栋樑, 仲俊峰, 黄兵, 等. 三叉神经痛颅外射频热凝舒适化治疗的流程与监护管理[J]. 中华全科医学, 2021, 19(1): 141-145. doi: 10.16766/j.cnki.issn.1674-4152.001751 CHEN D L, ZHONG J F, HUANG B, et al. Procedure and monitoring management of extracranial radiofrequency thermocoagulation for trigeminal neuralgia[J]. Chinese Journal of General Practice, 2021, 19(1): 141-145. doi: 10.16766/j.cnki.issn.1674-4152.001751
[6]	DI STEFANO G, DE STEFANO G, LEONE C, et al. Real-world effectiveness and tolerability of carbamazepine and oxcarbazepine in 354 patients with trigeminal neuralgia[J]. Eur J Pain, 2021, 25(5): 1064-1071. doi: 10.1002/ejp.1727
[7]	MELEK L N, SMITH J G, KARAMAT A, et al. Comparison of the neuropathic pain symptoms and psychosocial impacts of trigeminal neuralgia and painful posttraumatic trigeminal neuropathy[J]. J Oral Facial Pain Headache, 2019, 33(1): 77-88. doi: 10.11607/ofph.2157
[8]	郭楠, 秦响, 汪秀玲. MRI 3D-TOF联合3D-FIESTA对原发性三叉神经痛三叉神经形态学和疼痛程度相关性的研究[J]. 神经损伤与功能重建, 2021, 16(1): 48-50. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF202101015.htm GUO N, QIN X, WANG X L. MRI 3D-TOF combined with 3D-FIESTA to study the correlation between trigeminal nerve morphology and pain degree in primary trigeminal neuralgia[J]. Neural Injury and Functional Reconstruction, 2021, 16(1): 48-50. https://www.cnki.com.cn/Article/CJFDTOTAL-GWKF202101015.htm
[9]	郭楠, 汪秀玲. 原发性三叉神经痛的MRI研究进展[J]. 放射学实践, 2021, 36(7): 942-946. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202107035.htm GUO N, WANG X L. Research progress of MRI in primary trigeminal neuralgia[J]. Radiologic Practice, 2021, 36(7): 942-946. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202107035.htm
[10]	JUNG G H, YOU S J. Evaluation of hematologic profile may be needed for patients treated with oxcarbazepine[J]. Korean J Pediatr, 2019, 62(8): 312-316. doi: 10.3345/kjp.2019.00017
[11]	李淑贤, 黄现平, 张玉冰, 等. 卡马西平联合阿米替林治疗原发性三叉神经痛的临床研究[J]. 癫痫与神经电生理学杂志, 2021, 30(1): 51-54. https://www.cnki.com.cn/Article/CJFDTOTAL-OBED202101012.htm LI S X, HUANG X P, ZHANG Y B, et al. Clinical study of carbamazepine combined with amitriptyline in the treatment of primary trigeminal neuralgia[J]. Journal of Epileptology and Electroneurophysiology, 2021, 30(1): 51-54. https://www.cnki.com.cn/Article/CJFDTOTAL-OBED202101012.htm
[12]	DI STEFANO G, DE STEFANO G, LEONE C, et al. Concomitant continuous pain in patients with trigeminal neuralgia is associated with trigeminal nerve root atrophy[J]. Cephalalgia, 2020, 40(13): 1502-1510. doi: 10.1177/0333102420949206
[13]	DI STEFANO G, YUAN J H, CRUCCU G, et al. Familial trigeminal neuralgia: A systematic clinical study with a genomic screen of the neuronal electrogenisome[J]. Cephalalgia, 2020, 40(8): 767-777. doi: 10.1177/0333102419897623
[14]	ABDEL-RAHMAN K A, ELAWAMY A M, MOSTAFA M F, et al. Combined pulsed and thermal radiofrequency versus thermal radiofrequency alone in the treatment of recurrent trigeminal neuralgia after microvascular decompression: A double blinded comparative study[J]. Eur J Pain, 2020, 24(2): 338-345. doi: 10.1002/ejp.1489
[15]	REN H, ZHAO C M, WANG X D, et al. The efficacy and safety of the application of pulsed radiofrequency, combined with low-temperature continuous radiofrequency, to the gasserian ganglion for the treatment of primary trigeminal neuralgia: Study protocol for a prospective, open-label, parall, randomized controlled trial[J]. Pain Physician, 2021, 24(1): 89-97.
[16]	WANG T T, XU S J, HE Q L, et al. Efficacy and safety of radiofrequency thermocoagulation with different puncture methods for treatment of v1 trigeminal neuralgia: A prospective study[J]. Pain physician, 2021, 24(2): 145-152.