摘要
目的探讨显微血管减压术（MVD）治疗脑神经疾患的手术技巧，以提高手术疗效、减少并发症。方法回顾性分析2008年4月至2016年2月武警后勤学院附属医院神经外科行MVD治疗并获得随访的1576例脑神经疾患患者的临床资料。分为2013年12月之前手术治疗的传统手术组（实施经典MVD，共613例）和2013年12月之后手术治疗的技术改进组（增加了神经电生理监测、责任血管悬吊法、多点垫离减压法等技术改进方法，共963例）。比较两组患者的术后疗效及并发症，并进行统计学分析。结果1576例患者随访13～73个月，平均（37．2±11．4）个月。三叉神经痛患者传统手术组的有效率为92．66％（265／286），复发率为6．30％（18／286），并发症发生率为10．84％（31／286）；技术改进组的有效率为96．14％（374／389），复发率为2．83％（11／389），并发症发生率为5．91％（23／389）。面肌痉挛患者传统手术组的有效率为94．30％（298／316），复发率为7．00％（22／316），并发症发生率为11．08％（35／316）；技术改进组的有效率97．07％（530／546），复发率为2．75％（15／546），并发症发生率为5．13％（28／546）。上述指标在两组间的差异均有统计学意义（均P〈0．05）。结论MVD是治疗脑神经疾患安全、有效的手术方法。术中应用神经电生理监测、责任血管悬吊法、多点垫离减压法等可以提高手术疗效，降低并发症的发生率。
Objective To investigate surgical techniques of microvascular decompression （MVD） for cranial nerve disorders to further improve the efficacy and reduce the complications. Methods A retrospective study was conducted on 1 576 patients with cranial nerve disorders who underwent MVD and follow-up at Department of Neurosurgery, Affiliated Hospital of Logistics College of PAP, from April 2008 to February 2016. The 613 patients undergoing conventional MVD before December 2013 belonged to traditional surgery group. The remaining 963 patients undergoing MVD with technical modification after December 2013 were classified into modified surgery group. The modifications included employment of neurological electrophysiological monitoring, slinging of the offending vessel, multi-point decompression and et al. The effective rate and complication rate were compared post procedure between the two groups and the statistical data were analyzed. Results All 1 576 patients were followed up for 13 -73 months with an average of 37. 2 ± 11. 4 months. For trigeminal neuralgia, the effective rate, recurrence rate and complication rate were 92.66% （265/286） , 6.30% （18/286） and 10.84% （31/286） , respectively in traditional surgery group, and 96.14% , 2.83% and 5.91% , respectively in modified surgery group. For hemifacial spasm, the effective rate, recurrence rate and complication rate were 94.30% , 7.00% and 11.08% , respectively in traditional surgery group, and were 97.07%, 2.75% and 5.13%, respectively in modified group. The inter-group differences in the parameters above were statistically significant （P 〈 0. 05 ）. Conclusions MVD is a safe and effective surgical method for the treatment of cranial nerve disorders. The application of intraoperative eleetrophysiology monitoring, sling retraction of the offending vessel and multi-point decompression could increase the efficacy and reduce the complications of MVD.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第9期883-886,共4页
Chinese Journal of Neurosurgery
基金
国家自然科学基金（81471275）
关键词
显微血管减压术
脑神经疾病
治疗结果
手术后并发症
Microvascular decompression
Cranial nerve disease
Treatment outcome
Postoperative complications
