经皮微球囊压迫术对三叉神经...痛缓解及氧化应激指标的影响_张源.pdf

经皮微球囊压迫术对三叉神经痛患者疼痛缓解及氧化应激指标的影响作者简介:张源，男，主治医师，医学硕士，研究方向:神经外科疾病诊治。E-mail:cwfteqq2 163com 本文引用格式 张源，张文进，梁阿铭经皮微球囊压迫术对三叉神经痛患者疼痛缓解及氧化应激指标的影响 J 右江医学，2023，51(1):51-55张源，张文进，梁阿铭(郑州大学附属郑州中心医院神经外科，河南郑州 450000)【摘要】目的探讨不同的手术方式治疗三叉神经痛(trigeminal neuralgia，TN)患者的临床疗效。方法根据治疗方法不同将郑州中心医院 2018 年 12 月至 2021 年 3 月收治的 96 例 TN 患者分为压迫组、减压组，每组 48 例。压迫组予以经皮微球囊压迫术(PMC)治疗，减压组予以微血管减压术(MVD)治疗。对比两组围术期指标、术后当天及随访 1 年疼痛缓解情况、术前及术后 3 d 血清炎症介质水平、血清氧化应激指标水平及并发症情况。结果压迫组手术时间、住院时间短于减压组，住院费用低于减压组(P005);术后当天及随访 1 年压迫组疼痛缓解率 9167%(44/48)、9545%(42/44)分别与减压组 9583%(46/48)、9048%(38/42)比较，差异无统计学意义(P005);术后 3d 两组血清肿瘤坏死因子-(TNF-)、白介素(IL-1、IL-6)、丙二醛(MDA)、晚期氧化蛋白产物(AOPP)水平较术前升高，压迫组低于减压组，血清超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH-Px)水平较术前降低，压迫组高于减压组(P005);压迫组并发症总发生率 3750%(18/48)较减压组 1458%(7/48)高(P005)。结论PMC 与MVD 治疗 TN 均能缓解患者疼痛，且有较好的远期疗效，但 PMC 能优化手术情况，减轻机体损伤，降低炎症及应激反应程度，有助于术后恢复，但术后并发症风险高。【关键词】三叉神经痛;微血管减压术;经皮微球囊压迫术;炎症反应中图分类号:7451+1文献标志码:ADOI:103969/jissn1003-1383202301009Effects of percutaneous microballoon compression on pain relief andoxidative stress indicators in patients with trigeminal neuralgiaZHANG Yuan，ZHANG Wenjin，LIANG Aming(Department of Neurosurgery，Zhengzhou Central Hospital Affiliated toZhengzhou University，Zhengzhou 450000，Henan，China)【Abstract】ObjectiveTo investigate the clinical efficacy of different surgical methods in the treatment of patients withtrigeminal neuralgia(TN)MethodsAccording to different treatment methods，96 TN patients admitted in Zhengzhou Cen-tral Hospital Affiliated to Zhengzhou University from December 2018 to March 2021 were divided into compression group anddecompression group，with 48 cases in each group The compression group were treated with percutaneous microballoon com-pression(PMC)，and the decompression group were given microvascular decompression(MVD)The perioperative indexes，pain relief on the day of surgery and during the 1-year follow-up after operation，levels of serum inflammatory mediators andserum oxidative stress indicators before and 3 days after the operation，and complications were compared between the twogroups esultsThe operation time and hospital stay in the compression group were shorter than those in the decompressiongroup，and the hospitalization costs were lower than those in the decompression group(P005)The pain relief rates were9167%(44/48)and 9545%(42/44)in the compression group and 9583%(46/48)and 9048%(38/42)in the de-compression group on the day after operation and during the one-year follow-up，respectively，and the difference was not sta-tistically significant(P005)Three days after operation，the levels of serum tumor necrosis factor-(TNF-)，interleukin(IL-1，IL-6)，malondialdehyde(MDA)，and advanced oxidation protein product(AOPP)in both groups were higher15右江医学 2023 年第 51 卷第 1 期Chinese Youjiang Medical Journal 2023，Vol51 No1than those before operation，and those in the compression group were lower than those in the decompression group The levelsof serum superoxide dismutase(SOD)and glutathione peroxidase(GSH-Px)were lower than those before operation，and thelevels in the compression group were higher than those in the decompression group(P005)The total incidence of compli-cations in the compression group(3750%，18/48)was higher than that in the decompression group(1458%，7/48)(P005)ConclusionBoth PMC and MVD can relieve pain in patients with TN and have good long-term efficacy，PMC，onthe other hand，can optimize the operation，reduce body damage，inflammation and stress response，and contribute to postop-erative recovery，but the risk of postoperative complications is high【Key words】trigeminal neuralgia(TN);microvascular decompression(MVD);percutaneous microballoon compression(PMC);inflammatory response三叉神经痛(trigeminal neuralgia，TN)是以三叉神经支配区反复出现刺激性、电击剧烈疼痛为特征的神经疾病，有较高发病率且多见于老年群体，会造成血压异常，影响患者身心健康1-2。早期 TN 患者以药物治疗为主，虽能获得确切疗效，但部分患者机体敏感度较低，药物干预效果不佳，针对此类患者临床则建议手术治疗3。目前临床治疗 TN 术式较多，且以血管减压术(microvascular decompression，MVD)、经皮微球囊压迫术(percutaneous microbal-loon compression，PMC)应用较为广泛，虽能获得较为满意的临床疗效，但不同操作手段对患者造成的损伤也不尽相同4。本研究选取我院部分 TN 患者分组进行对照研究，旨在从疼痛缓解情况、炎症反应、应激反应及并发症等方面综合评估 PMC 的临床优劣。1资料与方法1111一一般般资料资料选取我院 2018 年 12 月至 2021 年3 月收治的 TN 患者 96 例，依据手术方法不同分为压迫组、减压组，各 48 例。压迫组男 27 例，女 21例;年龄 5068 岁，平均(5935395)岁;病程 934个月，平均(2377537)个月;体重指数 2026 kg/m2，平均(2283136)kg/m2;疼痛位置:左侧 23 例，右侧 25 例;受累神经:支 14 例，支 18 例，、支 16 例。减压组男 22 例，女 26 例;年龄 5271 岁，平均(6073529)岁;病程 1339 个月，平均(2435574)个月;体重指数2026 kg/m2，平均(2310140)kg/m2;疼痛位置:左侧 20 例，右侧 28 例;受累神经:支 11 例，支 20 例，、支 17 例。两组基线资料间差异均无统计学意义(P005)，有可比性。1212病例病例选选择择标标准准121121纳纳入入标标准准符合三叉神经痛诊疗中国专家共识5 中 TN 诊断标准;保守治疗无效患者;近期未接受其他相关治疗;无手术禁忌证;患者签署知情同意书。122122排除排除标标准准脏器功能严重不全者;精神疾病患者;合并严重且未控制糖尿病、高血压患者;合并颅面部血管性畸形或颅内动脉瘤患者。123123脱落脱落标标准准随访流程较为繁琐，导致患者主动退出试验;患者搬迁、外出务工导致失联。1313方方法法131131术术前前准准备备患者均完善核磁共振成像、颅骨X 线、CT 等检测及血管造影;均由同一医师于无菌环境下完成手术。132132压迫压迫组组实施 PMC，具体方法:患者仰卧插管实施全麻，消毒铺无菌巾;在 C 型臂 X 光机透视下采用 Hartel 穿刺技术于患侧口角外侧(25 cm)穿刺至卵圆孔开口处，退出针芯可见脑脊液流出，将4F 球囊沿穿刺针导入 Meckel 腔;以造影剂缓慢注入球囊，根据麦氏囊体积调整造影剂注射量，球囊压力维持(10001200 mmHg)，至球囊出现倒梨或哑铃状，压迫三叉神经半月节 3 min，退出穿刺针及导管，穿刺点压迫 5 min 止血。133133减压减压组组实施 MVD，具体方法:患者侧卧位，实施全麻，三钉头架固定头颅;选择乙状窦后入路于患侧耳后内上至横窦