CAJ | 학술논문

目的探讨三种不同定位方法在三叉神经半月节射频热凝术中的治疗效果及优缺点.方法 155例患者根据定位方法的不同分为A、B、C三组,A组为CT定位下徒手穿刺卵圆孔组,B组为立体定向CT引导下穿刺卵圆孔组,C组为立体定向CT-MR图像融合直接定位半月神经节组.分别对三组患者术中情况、手术并发症、疗效及预后进行比较.结果 A组一次性穿刺成功率33.87%,显著低于B组(92.98%)、C组(100%);术中心血管反应发生率A组48.39%,显著高于B组(14.04%)、C组(8.33%);手术时间A组亦显著长于B、C组.手术并发症方面A组发生率33.87%,B组21.05%,C组16.67%,三组间无显著性差异,主要为面部感觉减退,其他并发症A组显著高于B、C组.预后优良率A组80.65%,显著低于B组(94.74%)、C组(100%),术后复发率A组11.29%,显著高于B组(1.75%)、C组(0%).结论 CT定位下徒手穿刺卵圆孔操作方法简单,但穿刺存在较大肓目性,术中患者痛苦较大,心血管反应发生率高,手术时间延长,术后并发症相对较多,术后复发率偏高.立体定向CT引导下穿刺卵圆孔定位准确,术中患者痛苦较小,术后并发症少,复发率低,但仍为间接定位方法,不能直接定位半月神经节,如患者存在卵圆孔变异则手术难度较大.立体定向图像融合技术直接精确定位三叉神经半月节及穿刺路径,消除了穿刺盲区,显著提高了穿刺的准确性和治疗效果.
목적 탐토삼충불동정위방법재삼차신경반월절사빈열응술중적치료효과급우결점.방법 155례환자근거정위방법적불동분위A、B、C삼조,A조위CT정위하도수천자란원공조,B조위입체정향CT인도하천자란원공조,C조위입체정향CT-MR도상융합직접정위반월신경절조.분별대삼조환자술중정황、수술병발증、료효급예후진행비교.결과 A조일차성천자성공솔33.87%,현저저우B조(92.98%)、C조(100%);술중심혈관반응발생솔A조48.39%,현저고우B조(14.04%)、C조(8.33%);수술시간A조역현저장우B、C조.수술병발증방면A조발생솔33.87%,B조21.05%,C조16.67%,삼조간무현저성차이,주요위면부감각감퇴,기타병발증A조현저고우B、C조.예후우량솔A조80.65%,현저저우B조(94.74%)、C조(100%),술후복발솔A조11.29%,현저고우B조(1.75%)、C조(0%).결론 CT정위하도수천자란원공조작방법간단,단천자존재교대황목성,술중환자통고교대,심혈관반응발생솔고,수술시간연장,술후병발증상대교다,술후복발솔편고.입체정향CT인도하천자란원공정위준학,술중환자통고교소,술후병발증소,복발솔저,단잉위간접정위방법,불능직접정위반월신경절,여환자존재란원공변이칙수술난도교대.입체정향도상융합기술직접정학정위삼차신경반월절급천자로경,소제료천자맹구,현저제고료천자적준학성화치료효과.
Objective To explore the therapeutic efficacy and advantages and disadvantages of three different locating methods of radiofrequency thermocoagulation for trigeminal neuralgia on semilunar ganglion. Methods Based on different locating methods, 155 patients were divided into groups A, B, and C. Group A received freehand puncturing foramen ovule cranium by CT guidance, group B received puncturing foramen ovule cranium by CT-guided stereotaxis, and group C received direct determining semilunar ganglion by CT-MR image fusion stereotaxis. The intraoperative conditions, surgical complications, efficacy, and prognosis were compared among the three group. Results The success rate of first puncture was significantly lower in group A (33.87%) than in group B (92.98%) or group C (100%). The incidence of intraoperative cardiovascular effects was 48.39% in group A and markedly greater than group B (14.04%) or group C (8.33%). The surgical time was longer in group A in group B or C. The rate of surgical complications was 33.87% in group A, 33.87% in group B, and 16.67% in group C, mainly facial hypaesthesia, which was no significant difference. Other surgical complications were higher in group A than in group B or C. The rate of ideal prognosis was 80.65% in group A, which was significantly lower than in group B (94.74%) or group C (100%). The postoperative recurrence rate was significantly higher in group A than in group B or C (11.29% vs. 1.75% vs. 0%). Conclusions The method of freehand puncturing foramen ovule cranium by CT orientation is simple but existing major blindness, moreover patients have greater painful at surgery, more incidence rate of intra- operative cardiovascular reactions, surgical complications, longer surgical time, higher postoperative recur- rence rate. The method of puncturing foramen ovule cranium by CT-guided stereotaxis is accurate in localization. Patients have slight pain at surgery, less incidence rate of intraoperative cardiovascular events and surgical complications, shorter surgical time, lower postoperative recurrence rate, but the deficiency is indirect local- ization can怏, directly puncture semilunar ganglion, increasing surgical difficulties if there are variations in foramen ovule cranium. The stereotaxis image fusion technique can directly and accurately locating semilunar ganglion and puncturing path, eliminating puncturing blind areas, and significantly increasing puncture accuracy and efficacy.