本文選題：微血管減壓術(shù)　切入點(diǎn)：面肌痙攣　出處：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:評(píng)價(jià)微血管減壓術(shù)治療面肌痙攣的療效,分析責(zé)任血管類型與微血管減壓術(shù)療效的關(guān)系。方法:回顧性分析2014年3月-2015年12月期間,河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)外科住院,接受微血管減壓術(shù)治療的80例原發(fā)性面肌痙攣病人,入院后均行顱腦MRI平掃以及3D-TOF-MRA成像和3D-FIESTA序列檢查,除外繼發(fā)性病因,行微血管減壓術(shù),術(shù)中顯露面神經(jīng)出腦干區(qū),根據(jù)影像學(xué)資料與手術(shù)所見(jiàn),探明責(zé)任血管,按照其類型不同分成兩組:椎-基底動(dòng)脈壓迫組(責(zé)任血管含有椎-基底動(dòng)脈)17例;小血管壓迫組(責(zé)任血管不含椎-基底動(dòng)脈)63例。松解壓迫面神經(jīng)的責(zé)任血管,在責(zé)任血管與腦干間置入適量的Teflon墊片,觀察及跟蹤病人的療效與并發(fā)癥情況,進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:觀察并隨訪12-30個(gè)月,治愈46例(57.50%),改善25例(31.25%),無(wú)效9例(11.25%),有效(治愈與改善)71例,總有效率為88.75%,椎-基底動(dòng)脈壓迫組有效12例(70.60%),小血管壓迫組有效59例(93.70%),椎-基底動(dòng)脈壓迫組療效較小血管壓迫組差,兩組療效差異有統(tǒng)計(jì)學(xué)意義(P=0.008)。出現(xiàn)延遲治愈23例(28.75%),椎-基底動(dòng)脈壓迫組8例(47.06%),小血管壓迫組15例(23.81%),椎-基底動(dòng)脈壓迫組延遲治愈發(fā)生率較小血管壓迫組高,兩組延遲治愈發(fā)生率無(wú)統(tǒng)計(jì)學(xué)意義(P=0.060)。出現(xiàn)復(fù)發(fā)3例(3.75%),其中椎-基底動(dòng)脈壓迫組1例,小血管壓迫組2例。并發(fā)癥主要為聽(tīng)力下降出現(xiàn)8例,遲發(fā)型面癱出現(xiàn)4例。Logistic回歸分析:變量責(zé)任血管類型P值為0.027,OR值為5.867,95%CI:1.228-28.018。責(zé)任血管包含椎-基底動(dòng)脈是手術(shù)療效差的獨(dú)立危險(xiǎn)因素。結(jié)論:微血管減壓術(shù)目前治療原發(fā)性面肌痙攣的有效率高,復(fù)發(fā)、無(wú)效及并發(fā)癥發(fā)生率較低。責(zé)任血管含有椎-基底動(dòng)脈的面肌痙攣患者微血管減壓術(shù)療效較差。
[Abstract]:Objective: to evaluate the efficacy of microvascular decompression in the treatment of hemifacial spasm, and to analyze the relationship between the type of responsible vessels and the efficacy of microvascular decompression. 80 cases of primary hemifacial spasm treated by microvascular decompression were treated by neurosurgery, the second Hospital of Hebei Medical University. After admission, all patients underwent MRI plain scan, 3D-TOF-MRA imaging and 3D-FIESTA sequence examination, except for secondary etiology. After microvascular decompression, the facial nerve came out of the brainstem area during the operation. According to the imaging data and the operative findings, the responsible vessels were identified and divided into two groups according to their different types: vertebrobasilar artery compression group (17 cases of the responsible vessels containing vertebrobasilar artery); In the small vessel compression group (63 cases of the responsible vessel without vertebrobasilar artery), the responsible vessel of the facial nerve was released and the appropriate amount of Teflon gasket was placed between the responsible vessel and the brainstem to observe and follow up the curative effect and complications of the patient. Results: after observation and follow-up for 12-30 months, 46 cases were cured (57.50), 25 cases improved (31.25%), 9 cases were ineffective (11. 25%), 71 cases were cured and improved. The total effective rate was 88.75. 12 cases were effective in vertebrobasilar artery compression group, 59 cases were effective in small vessel compression group. The effect of vertebrobasilar artery compression group was worse than that of small vessel compression group. The difference between the two groups was statistically significant. There were 23 cases of delayed cure, 8 cases of vertebrobasilar artery compression group (n = 8) and 15 cases of small vessel compression group (n = 15). The incidence of delayed cure in vertebrobasilar artery compression group was higher than that in small vessel compression group. There was no significant difference in the incidence of delayed cure between the two groups. There were 3 cases of recurrence (1 case in vertebrobasilar artery compression group and 2 cases in small vessel compression group). The main complication was hearing loss in 8 cases. Logistic regression analysis of 4 cases with delayed facial palsy: variable responsible vessel type P = 0.027 OR = 5.867% 95 CI: 1.228-28.018.The responsible vessel contains vertebrobasilar artery is an independent risk factor for poor surgical efficacy. Conclusion: microvascular decompression is an independent risk factor for the current treatment of microvascular decompression. The effective rate of hemifacial spasm is high, The incidence of recurrence, ineffectiveness and complications was low. Microvascular decompression was poor in patients with facial spasm with vertebrobasilar artery.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 鄭瑛;鄭魯;吳英超;趙中甫;楚燕飛;姚智強(qiáng);劉華;李雅斌;張勝利;劉妍;劉博;劉軼剛;張謙生;常書(shū)鋒;;顯微血管減壓術(shù)治療面肌痙攣的減壓與關(guān)顱改進(jìn)[J];中國(guó)微侵襲神經(jīng)外科雜志;2015年04期

2 李世亭;王旭輝;;面肌痙攣的診斷與治療[J];中華神經(jīng)外科疾病研究雜志;2011年06期

3 左煥琮;陳國(guó)強(qiáng);袁越;韓宏彥;王世杰;王巖;王曉松;;顯微血管減壓術(shù)治療面肌痙攣20年回顧(附4260例報(bào)告)[J];中華神經(jīng)外科雜志;2006年11期

4 袁越,王巖,張思迅,張黎,李銳,郭京;顯微血管減壓術(shù)治療面肌痙攣的臨床研究(附1200例報(bào)告)[J];立體定向和功能性神經(jīng)外科雜志;2004年04期

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