老年特发性三叉神经痛应用微血管减压与伽玛刀放射外科术的疗效比较【摘要】目的探讨老年特发性三叉神经痛应用微血管减压与伽玛刀放射外科术的疗效差异方法选择2013年11月至2015年11月我院接诊的90例特发性三叉神经痛的老年患者，通过手术方式不同分为微血管减压组（n=45）和伽玛刀组（n=45），比较两组术后3个月疗效，并进行12个月随访，记录术前术后视觉模拟评分法（VAS），并记录并发症以及疼痛复发率。结果两组术后3个月疗效总缓解率比较无显著差异[88.89%（40/45）vs82.22%（37/45）]（P＞0.05）；两组术后VAS评分较治疗前均得到显著降低（P＜0.05），两组术后1个月VAS评分比较无显著差异（P＞0.05），但微血管减压组在术后3个月、6个月、9个月、12个月时VAS评分均明显比伽玛刀组低，比较均具有统计意义（P＜0.05）；两组术后感染、恶心呕吐、耳鸣、面部麻木、听力障碍总发生率比较无显著差异[17.78%（8/45）vs15.56%（7/45）]（P＞0.05）；在12个月的随访过程中，微血管减压组疼痛复发率明显比伽玛刀组低[11.11%（5/45）vs28.89%（13/45）]，差异具有统计学意义（P＜0.05）。结论微血管减压术和伽马刀放射术均可缓解老年特发性三叉神经痛，但微血管减压术在远期疼痛缓解率和复发率上均优于伽马刀放射术，更利于基础状况良好的老年患者治疗，但对于基础情况较差或不能耐受手术的患者，伽马刀放射术也可以作为较好的姑息治疗术式。【关键词】老年特发性三叉神经痛；微血管减压术；伽玛刀放射术；疼痛Comparisonofmicrovasculardecompressionandgammakniferadiosurgeryinthetreatmentofidiopathictrigeminalneuralgiaintheelderly【Abstract】ObjectiveTostudythecurativeeffectdifferenceofmicrovasculardecompressionandgammakniferadiosurgeryinthetreatmentofidiopathictrigeminalneuralgiaintheelderly.Methods90patientsofidiopathictrigeminalneuralgiaintheelderlywhoreceivedtherapyfromNovember2013toNovember2015inourhospitalwereselected.accordingtodifferentsurgicalmethods,thosepatientsweredividedintothemicrovasculardecompressiongroup(n=45)andthegammaknifegroup(n=45).Thecurativeeffectwascomparedbetweenthetwogroupsafter3months,andthepatientswerefollowedupfor12months,andthevisualanaloguescale(VAS)wasrecordedbeforeandaftertheoperation,andthecomplicationandpainrecurrenceratewererecord.ResultsTherewasnosignificantdifferenceinthetotalremissionratebetweenthetwogroupsafter3months[88.89%(40/45)vs82.22%(37/45)]（P＞0.05);theVASscoresinthetwogroupsweresignificantlylowerthanthosebeforetreatment(P＜0.05),therewasnosignificantdifferenceinVASscorebetweenthetwogroupsafteroperation1months(P＞0.05),buttheVASscoresinthemicrovasculardecompressiongroupweresignificantlylowerthanthoseofthegammaknifegroupatafteroperation3,6,9and12months,thedifferencewasstatisticallysignificant(P＜0.05);therewasnosignificantdifferenceintheincidenceofpostoperativeinfection,nausea,vomiting,tinnitus,facialnumbnessandhearingimpairmentbetweenthetwogroups[17.78%(8/45)vs15.56%(7/45)](P＞0.05);thepainrecurrencerateinthemicrovasculardecompressiongroupwassignificantlylowerthanthoseofthegammaknifegroupat12monthsfollow-up[11.11%(5/45)vs28.89%(13/45)],thedifferencewasstatisticallysignificant(P＜0.05).ConclusionMicrovasculardecompressionsurgeryandgammakniferadiotherapycanrelievesenileidiopathictrigeminalneuralgia,butthemicrovasculardecompressionremissionrateandrecurrenceratewerebetterthanthatofgammakniferadiationinlong-termpain,it’smoreconducivetothetreatmentofelderlypatientswithgoodfoundation,Butforthebasisofpoororcannottoleratesurgery,gammakniferadiosurgeryalsocanbeusedasagoodpalliativetreatment.【Keywords】Idiopathictrigeminalneuralgiaintheelderly;Microva...
