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目的:分析CT引导下立体定向射频热凝三叉神经半月节对原发性三叉神经痛的疗效,探讨其临床适用性。方法:选择从2011年5月至2012年12月于我院住院治疗原发性三叉神经痛的58例患者,在三维CT引导下采用通过Brain LAB手术计划系统经前入路卵圆孔穿刺三叉神经半月神经节,术中根据疼痛分布范围射频热凝三叉神经半月节。观察并比较治疗前后的VAS评分,临床疗效,术中和术后不良反应情况。结果:58例患者的穿刺手术均成功,术后1d、3d、6d的VAS评分均较治疗前显著降低(P<0.01);1周后58例患者中,有53例患者疼痛完全消失,1例患者偶然出现疼痛,但无需服用药物处理,共显效54例;4例患者疼痛有所减轻或疼痛发作频率降低,但仍需服用药物,或服用药物剂量较治疗前明显减少;疼痛无改善或者非用药不能缓解的持续痛仅1例。总有效例数为57例,总有效率达98.26%。术中发生不良反应6例,在术后均有所缓解。术后发生各种并发症共15例,均未明显影响手术效果。结论:CT引导可以较为准确的进入穿刺部位,使立体定向射频热凝三叉神经半月节手术更加顺利,达到治疗原发性三叉神经痛的理想效果,适合临床长期推广应用。
OBJECTIVE: To analyze the curative effect of stereotactic radiofrequency thermocoagulation trigeminal nerve meniscus on primary trigeminal neuralgia guided by CT and discuss its clinical applicability. Methods: From May 2011 to December 2012 in our hospital for treatment of 58 cases of primary trigeminal neuralgia, under the guidance of three-dimensional CT using BrainLAB surgical planning system through the foramen ovale trigeminal approach Nerve ganglion, intraoperative radiofrequency trigeminal nerve meniscus according to the distribution of pain. The VAS score, clinical efficacy, intraoperative and postoperative adverse reactions were observed and compared before and after treatment. Results: The puncture operation was successful in all 58 patients. The VAS scores at 1, 3 and 6 days after operation were significantly lower than those before treatment (P <0.01). Fifty-three of the 58 patients disappeared completely after 1 week and 1 The patients had occasional pain but did not need medication. The total effective rate was 54 cases. The pain relief or pain frequency was reduced in 4 cases, but the dosage was still decreased or the dosage of the medication was still lower than that before treatment. Non-medication can not alleviate the sustained pain only 1 case. The total effective number of cases was 57 cases, the total effective rate was 98.26%. Intraoperative adverse reactions in 6 cases, were relieved after surgery. A total of 15 cases occurred after a variety of complications, did not significantly affect the surgical results. Conclusion: CT guidance can be more accurate access to the puncture site, so that stereotactic rf heat coagulation trigeminal nerve meniscus surgery more smoothly, to achieve the desired effect of treatment of primary trigeminal neuralgia, suitable for long-term clinical application.