论文部分内容阅读
目的:探讨伽玛刀放射外科(GKRS)治疗药物难治性三叉神经痛(TN)患者的长期疗效及其相关影响因素。方法:回顾性分析2009年1月至2019年9月内蒙古医科大学附属医院头部伽玛刀治疗中心采用GKRS治疗的293例药物难治性TN患者的临床资料。治疗后对所有患者进行临床随访，随访内容包括判断患者的疼痛缓解程度、并发症发生及复发情况。疼痛缓解程度依据巴罗神经学研究所(BNI)疼痛强度量表评级，其中Ⅰ～Ⅲb级为疼痛缓解有效，Ⅳ、Ⅴ级为疼痛缓解无效。采用单因素和多因素logistic回归分析法判断影响患者治疗后疼痛缓解和发生面部麻木的危险因素。结果:293例患者的中位随访时间为64个月(6～132个月)。至末次随访，270例患者疼痛缓解有效，另23例无效；疼痛有效缓解率为92.2%(270/293)。293例患者中，术后存在面部麻木伴蚁走感80例(27.3%)，单纯蚁走感26例(8.9%)，眼角抽搐14例(4.8%)，眼睛异物感、干涩等6例(2.0%)，耳鸣3例(1.0%)，味觉减退或丧失5例(1.7%)，咀嚼功能障碍4例(1.4%)。随访期间，17例(5.8%)患者复发；复发的中位时间为24个月(14～81个月)。多因素logistic回归分析结果显示，存在既往治疗史是影响患者治疗后疼痛缓解的危险因素(n OR＝3.419，95%n CI：1.264～9.248，n P＝0.015)，与照射剂量<80 Gy比较，80 Gy的照射剂量对疼痛的缓解效果好(n OR＝0.252，95%n CI：0.071～0.888，n P＝0.032)；存在既往治疗史(n OR＝2.533，95%n CI：1.194～5.373，n P＝0.015)和血管压迫神经(n OR＝5.865，95%n CI：2.538～13.556，n P<0.001)是影响患者治疗后出现面部麻木的危险因素。n 结论:采用GKRS治疗药物难治性TN的疼痛缓解率较高，治疗后并发症以面部麻木最常见。存在既往治疗史的TN患者疼痛缓解较差，术后易出现面部麻木；照射剂量80 Gy的患者疼痛缓解较好；存在血管压迫神经的患者术后易出现面部麻木。“,”Objective:To investigate the long-term efficacy and its influencing factors of gamma knife radiosurgery in the treatment of drug-refractory trigeminal neuralgia (TN).Methods:A retrospective study was conducted on the clinical data of 293 patients with drug-refractory TN who underwent gamma knife radiosurgery at the Head Gamma Knife Treatment Center, Affiliated Hospital of Inner Mongolia Medical University from January 2009 to September 2019. All patients underwent clinical follow-up post treatment. The content of follow-up included the assessment of pain relief degree, postoperative complications and recurrence. The degree of pain relief was rated according to the Pain Intensity Scale of the Barlow Institute of Neurology (BNI), in which BNI grade Ⅰ-Ⅲb grade indicated effectiveness for pain relief, and grade Ⅳ, Ⅴ was invalid for pain relief. Univariate and multivariate logistic regression analyses were used to determine the risk factors affecting postoperative pain relief and facial numbness.Results:The median follow-up time of 293 patients was 64 months (6-132 months). At the last follow-up, 270 patients had effective pain relief, and the other 23 had no pain relief; the effective pain relief rate was 92.2% (270/293). Among the 293 patients, facial numbness with crawling sensation was reported in 80 (27.3%) cases after operation, merely crawling sensation in 26 (8.9%), twitching in the corner of eye in 14 (4.8%), and eye foreign body sensation and dryness in 6 (2.0%), tinnitus in 3 (1.0%), severely affected taste in 5 (1.7%), and chewing dysfunction in 4 (1.4%). During the follow-up period, 17 patients (5.8%) reported recurrence. The median time to relapse was 24 months (14-81 months). The results of multivariate logistic regression analysis showed that the existence of previous treatment history was an independent risk factor for postoperative pain relief (n OR=3.419, 95%n CI: 1.264-9.248, n P=0.015). The pain relief rate was higher in the patients who′s radiation dose were 80 Gy compared with those less than 80 Gy(n OR=0.252, 95%n CI: 0.071~0.888, n P=0.032). The existence of previous treatment history (n OR=2.533, 95%n CI: 1.194-5.373, n P=0.015) and vascular compression of nerves (n OR=5.865, 95%n CI: 2.538-13.556, n P<0.001) were independent risk factors for facial numbness after surgery.n Conclusions:The treatment of drug-refractory TN using gamma knife radiosurgery is associated with a relatively high pain relief rate, and the most common postoperative complication is facial numbness. Patients with a history of previous treatment have poorer pain relief and a higher probability of facial numbness after surgery. Patients with a radiation dose of 80 Gy have better pain relief, and those with vascular compression of nerves also have a higher probability of facial numbness after surgery.