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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2016, Vol. 02 ›› Issue (05) : 278 -281. doi: 10.3877/cma.j.issn.2095-9141.2016.05.004

所属专题： 文献；

临床研究

枕下乙状窦后入路选择性舌咽神经迷走神经切断术治疗舌咽神经痛
宋昭1, 刘如恩2,†(), 杨艺3, 徐如祥3   
  1. 1. 518110　深圳，南方医科大学深圳医院神经外科
    2. 100029　北京，北京中日友好医院神经外科
    3. 100700　北京，陆军总医院附属八一脑科医院
  • 收稿日期:2016-03-17 出版日期:2016-10-15
  • 通信作者: 刘如恩

Treatment of glossopharyngeal neuralgia with the methold of selective glossopharyngeal and vagus nerve rhizotomy by suboccipital retrosigmoid approach

Zhao Song1, Ruen Liu2,†(), Yi Yang3, Ruxiang Xu3   

  1. 1. Department of Neurosurgery, Shenzhen Hospital of Southern Medical University, Shenzhen 518110, China
    2. Department of Neurosurgery, China-Japan Friendship Hospital, Beijing 100029, China
    3. The Affiliated Bayi Brain Hospital, The PLA Army General Hospital, Beijing 100700, China
  • Received:2016-03-17 Published:2016-10-15
  • Corresponding author: Ruen Liu
  • About author:
    Corresponding author: Liu Ruen, Email:
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宋昭, 刘如恩, 杨艺, 徐如祥. 枕下乙状窦后入路选择性舌咽神经迷走神经切断术治疗舌咽神经痛[J]. 中华神经创伤外科电子杂志, 2016, 02(05): 278-281.

Zhao Song, Ruen Liu, Yi Yang, Ruxiang Xu. Treatment of glossopharyngeal neuralgia with the methold of selective glossopharyngeal and vagus nerve rhizotomy by suboccipital retrosigmoid approach[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(05): 278-281.

目的

探讨枕下乙状窦后入路选择性舌咽神经、迷走神经部分根丝切断术治疗舌咽神经痛的有效性及安全性。

方法

选择自2010年4月至2015年6月收治于陆军总医院附属八一脑科医院的原发性舌咽神经痛患者34例，其中12例行微血管减压（MVD）+舌咽神经根切断术（PR），22例行PR+迷走神经根1~2组根丝切断术（VR），观察远期治愈率、近期并发症及远期并发症。两组患者远期疗效、近期总并发症及远期总并发症的发生采用百分率（%）表示，率之间的比较使用卡方检验。

结果

MVD+PR组术后10例立即无疼痛，2例仍有疼痛，2例术后有复发，远期治愈率66.7%；PR+VR组术后21例立即无疼痛，1例仍有疼痛，无复发，远期治愈率95.5%；PR+VR组患者远期治愈率高于MVD+PR组患者，且差异有统计学意义（χ2=5.130，P<0.05）。MVD+PR组共3例有近期并发症，近期总并发症发生率25.0%，PR+VR组共10例有近期并发症，近期总并发症发生率45.5%，两组间近期总并发症发生率差异无统计学意义（χ2=1.376，P>0.05）；MVD+PR组共2例遗留远期并发症，远期总并发症发生率16.7%，PR+VR组共5例遗留远期并发症，远期总并发症发生率22.7%，两组间远期总并发症发生率差异无统计学意义（χ2=0.174，P>0.05）。

结论

选择性PR+VR是安全的，其疗效优于MVD+PR，应积极选择PR+VR治疗GPN。

关键词: 舌咽神经痛, 舌咽神经切断术, 枕下乙状窦后入路
Objective

To investigate the effectiveness and safety of surgical treatment of glossopharyngeal neuralgia with the methold of selective glossopharyngeal nerve root and vagus nerve root silk rhizotomy by suboccipital retrosigmoid approach.

Methods

Of 34 patients with glossopharyngeal neuralgia admitted to the Army General Hospital Affiliated Brain Hospital of Bayi primary from April 2010 to June 2015, 12 cases were treated with microvascular decompression (MVD)+glossopharyngeal nerve root rhizotomy (PR), 22 cases were treated with PR + vagus nerve root 1~2 group rhizotomy (VR), and then observe the long-term cure rate, short-term complications and long-term complications. The datas were analyzed with SPSS 19.0 statistical analysis software, long-term curative effect, recent total complications and long-term total complications in two groups of patients were expressed by percentage (%), χ2 test was used to the comparison of the rate of two groups. If P<0.05, the difference was statistically significant.

Results

10 cases after operation in group MVD+PR were immediately and without pain, there were still 2 cases of pain and 2 cases of postoperative recurrence, long-term cure rate was 66.7%; 21 cases after operation in group PR+VR were immediately and without pain, 1 case was still pain and no recurrence, long-term cure rate was 95.5%. Long-term cure rate between the two groups had significant difference (χ2=5.130, P<0.05). MVD+PR group: There were a total of 3 cases with recent complications, recent total complication rates were 25.0%, PR+VR group:There were a total of 10 cases with recent complications, recent total complication rates were 45.5%, recent total complication rates between the two groups have no significant difference (χ2=1.376, P>0.05); MVD+PR group left 2 cases of long-term complications, legacy total complication rates were 16.7%, PR+VR group left 5 cases of long-term complications, legacy total complication rates were 22.7%, the legacy total incidence of complications between the two groups have no significant difference(χ2=0.174, P>0.05).

Conclusion

selective PR+VR was safe, and its curative effect was better than the MVD+PR, PR+VR therapy should be actively choosed in patients with GPN.

Key words: Glossopharyngeal neuralgia, Glossopharyngeal nerve root rhizotomy, Suboccipital retrosigmoid approach
图1 左侧原发性舌咽神经痛患者显微镜下MVD+PR手术中图片
图2 左侧原发性舌咽神经痛患者显微镜下PR+VR手术中图片
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