CAJ | 학술논문

目的：对微血管减压（MVD）和经皮穿刺球囊压迫（PBC）手术治疗原发性三叉神经痛的临床疗效进行前瞻性分析对比研究，从而可能为临床决策提供较可靠的循证医学依据。方法：利用2010年间杭州市第一人民医院住院三叉神经痛患者，建立前瞻队列研究患者数据库。分为MVD组和PBC组各30例。在术后第0～36个月，由独立观察者对临床疗效进行随访。分级资料比较使用卡方检验，计量资料比较使用t检验，面部疼痛预后采用Kaplan-Meier生存分析，研究终点为随访期结束或出现重度复发。结果：至研究终点，共计纳入60例患者。术前一般资料与文献数据大致相仿，对比无痛生存、轻度复发和重度复发，MVD组要优于PBC组，差异有统计学意义（P＜0．05）。就无痛生存期来说，MVD组1年为96．7％，3年为93．3％；PBC组1年为90．0％，3年为83．3％。就3年随访期而言，无论是MVD还是PBC复发多集中在1年左右。结论：由于有可治愈性以及非毁损性的特点，MVD术仍是体质健康三叉神经痛患者的主要治疗手段，与PBC术相比有更高的疼痛缓解率和更长的无痛生存期。
목적：대미혈관감압（MVD）화경피천자구낭압박（PBC）수술치료원발성삼차신경통적림상료효진행전첨성분석대비연구，종이가능위림상결책제공교가고적순증의학의거。방법：이용2010년간항주시제일인민의원주원삼차신경통환자，건립전첨대렬연구환자수거고。분위MVD조화PBC조각30례。재술후제0～36개월，유독립관찰자대림상료효진행수방。분급자료비교사용잡방검험，계량자료비교사용t검험，면부동통예후채용Kaplan-Meier생존분석，연구종점위수방기결속혹출현중도복발。결과：지연구종점，공계납입60례환자。술전일반자료여문헌수거대치상방，대비무통생존、경도복발화중도복발，MVD조요우우PBC조，차이유통계학의의（P＜0．05）。취무통생존기래설，MVD조1년위96．7％，3년위93．3％；PBC조1년위90．0％，3년위83．3％。취3년수방기이언，무론시MVD환시PBC복발다집중재1년좌우。결론：유우유가치유성이급비훼손성적특점，MVD술잉시체질건강삼차신경통환자적주요치료수단，여PBC술상비유경고적동통완해솔화경장적무통생존기。
Objective To compare clinical outcome of microvascular decompression (MVD) and percutaneous balloon compression (PBC) by using a prospective cohort study in order to provide a reliable evidence for the clinical decision-making. Methods Patients with trigeminal neuralgia hospitalized at Hangzhou First People′s Hospital in 2010 were chosen as database for cohort study. The patients were divided into MVD group (30 cases) and PBC group (30 cases). The clinical efficacy was followed by independent observers for 36 months after surgery. Chi-square test for hierarchical data, t test for quantitative data, and Kaplan-Meier plot for clinical outcomes were applied in the research. The endpoint was follow-up accomplishment or severe occurrence. Results Sixty patients were included in the research till the endpoint. The general records before surgery were almost the same with the literature records. By comparing painless period, mild and severe relapse, MVD group was superior to PBC group (P < 0.05). As for the painless survival period, MVD group was 96.7% of pain free after 1 year, 93.3% after 3 years, while PBC group was 90.0% after 1 year and 83.3% after 3 years. Regarding 3 years of follow-up, the relapse seemed occurred after 1 year in both groups. Conclusions As a curative and nondestructive procedure , MVD is more effective and has longer lasting pain free period , which should be considered as the first choice of treatment for trigeminal neuralgia in healthy people.