【摘要】目的 探討老年特發性三叉神經痛應用微血管減壓與伽瑪刀放射外科術的療效差異 方法 選擇2013年11月至2015年11月我院接診的90例特發性三叉神經痛的老年患者，通過手術方式不同分為微血管減壓組（n=45）和伽瑪刀組（n=45），比較兩組術后3個月療效，并進行12個月隨訪，記錄術前術后視覺模擬評分法（VAS），并記錄并發癥以及疼痛復發率。結果 兩組術后3個月療效總緩解率比較無顯著差異[88.89%（40/45）vs82.22%（37/45）]（P＞0.05）；兩組術后VAS評分較治療前均得到顯著降低（P＜0.05），兩組術后1個月VAS評分比較無顯著差異（P＞0.05），但微血管減壓組在術后3個月、6個月、9個月、12個月時VAS評分均明顯比伽瑪刀組低，比較均具有統計意義（P＜0.05）；兩組術后感染、惡心嘔吐、耳鳴、面部麻木、聽力障礙總發生率比較無顯著差異[17.78%（8/45）vs15.56%（7/45）]（P＞0.05）；在12個月的隨訪過程中，微血管減壓組疼痛復發率明顯比伽瑪刀組低[11.11%（5/45）vs28.89%（13/45）]，差異具有統計學意義（P＜0.05）。結論 微血管減壓術和伽馬刀放射術均可緩解老年特發性三叉神經痛，但微血管減壓術在遠期疼痛緩解率和復發率上均優于伽馬刀放射術，更利于基礎狀況良好的老年患者治療，但對于基礎情況較差或不能耐受手術的患者，伽馬刀放射術也可以作為較好的姑息治療術式。
Comparison of microvascular decompression and gamma knife radiosurgery inthe treatment of idiopathic trigeminal neuralgia in the elderly
【Abstract】 Objective To study the curative effect difference of microvascular decompression and gamma knife radiosurgery in the treatment of idiopathic trigeminal neuralgia in the elderly. Methods 90 patients of idiopathic trigeminal neuralgia in the elderly who received therapy from November 2013 to November 2015 in our hospital were selected. according to different surgical methods,those patients were divided into the microvascular decompression group (n=45) and the gamma knife group (n=45). The curative effect was compared between the two groups after 3 months, and the patients were followed up for 12 months, and the visual analogue scale (VAS) was recorded before and after the operation, and the complication and pain recurrence rate were record. Results There was no significant difference in the total remission rate between the two groups after 3 months[88.89%(40/45)vs82.22%(37/45)]（P＞0.05); the VAS scores in the two groups were significantly lower than those before treatment(P＜0.05), there was no significant difference in VAS score between the two groups after operation 1 months(P＞0.05), but the VAS scores inthe microvascular decompression group were significantly lower than those of the gamma knife group at after operation 3, 6, 9 and 12 months, the difference was statistically significant (P＜0.05); there was no significant difference in the incidence of postoperative infection, nausea, vomiting, tinnitus, facial numbness and hearing impairment between the two groups[17.78%(8/45)vs15.56%(7/45)] (P＞0.05); the pain recurrence rate in the microvascular decompression group was significantly lower than those of the gamma knife group at 12 months follow-up[11.11%(5/45)vs28.89%(13/45)], the difference was statistically significant (P＜0.05). Conclusion Microvascular decompression surgery and gamma knife radiotherapy can relieve senile idiopathic trigeminal neuralgia, but the microvascular decompression remission rate and recurrence rate were better than that of gamma knife radiation in long-term pain, it’s more conducive to the treatment of elderly patients with good foundation, But for the basis of poor or can not tolerate surgery, gamma knife radiosurgery also can be used as a good palliative treatment.
【Keywords】Idiopathic trigeminal neuralgia in the elderly; Microvascular decompression; Gamma knife radiosurgery; Pain