完全神经内镜下显微血管减压术联合神经梳理术治疗原发性三叉神经痛的临床疗效及其对预后的影响

Observation on the therapeutic effect of microsurgical vascular decompression under complete neuroendoscopy combined with nerve combing surgery in the treatment of trigeminal neuralgia and its impact on prognosis

摘要:

目的 探究完全神经内镜下显微血管减压术（MVD）联合神经梳理术治疗原发性三叉神经痛（TN）的临床疗效及其及对预后的影响。方法 回顾性分析2021年11月－2023年11月该院收治的108例原发性TN患者的临床资料，根据不同手术方案，将患者分为联合组和对照组，各54例。对照组采用MVD治疗，联合组采用完全神经内镜下MVD联合神经梳理术治疗。比较两组患者总有效率、疼痛程度、应激指标、生活质量和并发症发生情况。结果 联合组总有效率为96.30%，明显高于对照组的83.33%，差异有统计学意义（P < 0.05）；两组患者术后视觉模拟评分法（VAS）评分明显低于术前，且联合组明显低于对照组，差异均有统计学意义（P < 0.05）；两组患者术后去甲肾上腺素（NE）、超氧化物歧化酶（SOD）和皮质醇（Cor）水平较术前明显升高，但联合组明显低于对照组，差异均有统计学意义（P < 0.05）；两组患者术后生活质量综合评定问卷（GQOL-74）评分明显高于术前，且联合组高于对照组，差异均有统计学意义（P < 0.05）；两组患者并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 完全神经内镜下MVD联合神经梳理术治疗原发性TN，可减轻疼痛，减轻应激反应，提高患者生活质量。值得临床推广应用。

Abstract:

Objective To explore the therapeutic effect of microsurgical vascular decompression (MVD) under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary trigeminal neuralgia (TN), and its impacts on prognosis.Methods 108 primary TN patients from November 2021 to November 2023 were retrospectively selected and grouped into combined group and control group based on the surgical plan, with 54 cases in each group. The control group received MVD treatment under the microscope, while the combined group received complete neuroendoscopic MVD combined with nerve combing surgery. The total effective rate, pain degree, stress indicators, quality of life, and complications were compared between the two groups.Results The total effective rate of the combined group (96.30%) was greatly higher than that of the control group (83.33%), the difference was statistically significant (P < 0.05). The visual analogue scale (VAS) scores of both groups after surgery were significantly lower than those before surgery, and the combined group was lower than the control group, the differences were statistically significant (P < 0.05). After surgery, the levels of norepinephrine (NE), superoxide dismutase (SOD), and cortisol (Cor) increased in both groups compared with those before surgery, but the combined group was greatly lower than that of the control group, the differences were statistically significant (P < 0.05). The generic quality of life inventory-74 (GQOL-74) scores in both groups after surgery were significantly higher than those before surgery, and the combined group was higher than the control group, the differences were statistically significant (P < 0.05). There was no difference of the total complication rate between the two groups (P > 0.05).Conclusion MVD under complete neuroendoscopy combined with nerve combing surgery in the treatment of primary TN, can relieve pain, reduce stress response and improve the quality of life of patients. It is worthy of clinical promotion and application.