CAJ | 학술논문

目的探讨显微外科手术治疗老年三叉神经痛患者的有效性与安全性.方法回顾性分析接受显微外科手术治疗的原发三叉神经痛患者143例,老年组92例,年龄65～82岁；中年51例为对照组,年龄40～62岁.采用枕下乙状窦后入路开颅,行微血管减压术(MVD),对未发现明确责任血管或血管压迫难以解除的患者行三叉神经感觉根部分切断术.随访时间2.1～2.6年,比较两组患者术后并发症、手术疗效等.结果老年组接受MVD手术的患者87例,术后疼痛完全缓解78例,部分缓解9例,随访79例,复发4例(5.1％);对照组接受MVD手术者49例,疼痛完全缓解45例,部分缓解4例,随访46例,复发3例(6.5％),两组疗效和复发率差异无统计学意义(P＞0.05).老年组术后有3例出现无菌性脑膜炎,听力下降、脑脊液漏、肺部感染、谵妄各1例；对照组无菌性脑膜炎、术后耳鸣及脑脊液漏各1例,两组患者的并发症发生率差异无统计学意义(P＞0.05).接受MVD治疗患者无面部感觉障碍.行三叉神经感觉根部分切断术的患者老年组5例,术后仅有1例偶有轻微疼痛,但无需药物治疗,4例疼痛均缓解；对照组2例疼痛均缓解,随访未发现复发病例,行三叉神经感觉根部分切断的患者,均有不同程度的面部感觉障碍；本组无死亡病例.结论老年患者的手术有其自身的特点,但如果处理得当,仍能获得良好的疗效及较高的手术安全性.
목적 탐토현미외과수술치료노년삼차신경통환자적유효성여안전성.방법 회고성분석접수현미외과수술치료적원발삼차신경통환자143례,노년조92례,년령65～82세；중년51례위대조조,년령40～62세.채용침하을상두후입로개로,행미혈관감압술(MVD),대미발현명학책임혈관혹혈관압박난이해제적환자행삼차신경감각근부분절단술.수방시간2.1～2.6년,비교량조환자술후병발증、수술료효등.결과 노년조접수MVD수술적환자87례,술후동통완전완해78례,부분완해9례,수방79례,복발4례(5.1％);대조조접수MVD수술자49례,동통완전완해45례,부분완해4례,수방46례,복발3례(6.5％),량조료효화복발솔차이무통계학의의(P＞0.05).노년조술후유3례출현무균성뇌막염,은력하강、뇌척액루、폐부감염、섬망각1례；대조조무균성뇌막염、술후이명급뇌척액루각1례,량조환자적병발증발생솔차이무통계학의의(P＞0.05).접수MVD치료환자무면부감각장애.행삼차신경감각근부분절단술적환자노년조5례,술후부유1례우유경미동통,단무수약물치료,4례동통균완해；대조조2례동통균완해,수방미발현복발병례,행삼차신경감각근부분절단적환자,균유불동정도적면부감각장애；본조무사망병례.결론 노년환자적수술유기자신적특점,단여과처리득당,잉능획득량호적료효급교고적수술안전성.
Objective To investigate the efficacy and safety of microsurgery for trigeminal neuralgia (TN) in elderly patients.Methods Totally 143 patients with intractable primary TN who received microsurgery were retrospectively analyzed.There were 92 cases in the elderly group with age of 65-82 years,and the other 51 cases in control group with age of 40-62 years.All the patients in both groups were classified as American Society of Anesthesiologists (ASA) Scale Grade 1 to 3.After suboccipital retrosigmoid craniotomy,microvascular decompression (MVD) was performed in 136patients and partial sensory trigeminal rhizotomy in 7 patients.The complications and efficacy were compared between the two groups.Results 87 cases in the elderly group and 49 cases in control group underwent MVD procedure,complete and part pain relief were achieved in 78 cases and 9 cases in the elderly group,45 cases and 4 cases in control group,respectively.After an average follow-up period of 2.6 and 2.1 years,4 cases (5.1％) among 79 follow-up cases and 3 cases (6.5％) among 46follow-up cases experienced TN recurrences in the elderly and control groups,respectively.No statistically significant differences existed in the efficacy and recurrence rate between the two groups (P＞0.05).There were 3 cases with aseptic meningitis,1 cases with hearing decrease,1 case with cerebrospinal fluid leakage,1 case with pulmonary infection and 1 cases with deliration in the elderlygroup,meanwhile,1 cases with aseptic meningitis,1 case with tinnitus and 1 case with cerebrospinal fluid leakage after surgery in control group (P＞0.05).No facial hypoesthesia appeared in the patients receiving MVD.5 cases in the elderly and 2 cases in control group underwent partial trigeminal rhizotomy with facial hypoesthesia,but the pain released,and no recurrence was found.There were no dead cases in both groups.Conclusions With cautious and proper treatment,microsurgical procedure can be performed safely and effectively in the elderly TN.