老年三叉神经痛患者的显微外科治疗谢红雯姜宏志袁庆国沙成杨玉明王大明目的探讨显微外科手术治疗老年三叉神经痛患者的有效性与安全性。方法回顾性分析接受显微外科手术治疗的原发三叉神经痛患者143例，老年组92例，年龄65～82岁；中年51例为对照组，年龄40～62岁。采用枕下乙状窦后入路开颅，行微血管减压术(MVD),对未发现明确责任血管或血管压迫难以解除的患者行三叉神经感觉根部分切断术。随访时间2.1～2.6年，比较两组患者术后并发症、手术疗效等。结果老年组接受MVD手术的患者87例，术后疼痛完全缓解78例，部分缓解9例，随访79例，复发4例(5.1％);对照组接受MVD手术者49例，疼痛完全缓解45例，部分缓解4例，随访46例，复发3例(6.5％)，两组疗效和复发率差异无统计学意义(P＞0.05)。老年组术后有3例出现无菌性脑膜炎，听力下降、脑脊液漏、肺部感染、谵妄各1例；对照组无菌性脑膜炎、术后耳鸣及脑脊液漏各1例，两组患者的并发症发生率差异无统计学意义(P＞0.05)。接受MVD治疗患者无面部感觉障碍。行三叉神经感觉根部分切断术的患者老年组5例，术后仅有1例偶有轻微疼痛，但无需药物治疗，4例疼痛均缓解；对照组2例疼痛均缓解，随访未发现复发病例，行三叉神经感觉根部分切断的患者，均有不同程度的面部感觉障碍；本组无死亡病例。结论老年患者的手术有其自身的特点，但如果处理得当，仍能获得良好的疗效及较高的手术安全性。三叉神经痛；显微外科手术；手术后并发症；减压术，外科MicrosurgeryfortrigeminalneuralgiainelderlypatientsXIEHong-wenJIANGHong-zhiYUANQing-guoSHAChengYANGYu-mingWANGDa-mingDepartmentofNeurosurgery,BeijingHospitalofMinistryofHealth,Beijing100730,ChinaObjectiveToinvestigatetheefficacyandsafetyofmicrosurgeryfortrigeminalneuralgia(TN)inelderlypatients.MethodsTotally143patientswithintractableprimaryTNwhoreceivedmicrosurgerywereretrospectivelyanalyzed.Therewere92casesintheelderlygroupwithageof65-82years,andtheother51casesincontrolgroupwithageof40-62years.AllthepatientsinbothgroupswereclassifiedasAmericanSocietyofAnesthesiologists(ASA)ScaleGrade1to3.Aftersuboccipitalretrosigmoidcraniotomy,microvasculardecompression(MVD)wasperformedin136patientsandpartialsensorytrigeminalrhizotomyin7patients.Thecomplicationsandefficacywerecomparedbetweenthetwogroups.Results87casesintheelderlygroupand49casesincontrolgroupunderwentMVDprocedure,completeandpartpainreliefwereachievedin78casesand9casesintheelderlygroup,45casesand4casesincontrolgroup,respectively.Afteranaveragefollow-upperiodof2.6and2.1years,4cases(5.1％)among79follow-upcasesand3cases(6.5％)among46follow-upcasesexperiencedTNrecurrencesintheelderlyandcontrolgroups,respectively.Nostatisticallysignificantdifferencesexistedintheefficacyandrecurrenceratebetweenthetwogroups(P＞0.05).Therewere3caseswithasepticmeningitis,1caseswithhearingdecrease,1casewithcerebrospinalfluidleakage,1casewithpulmonaryinfectionand1caseswithdelirationintheelderlygroup,meanwhile,1caseswithasepticmeningitis,1casewithtinnitusand1casewithcerebrospinalfluidleakageaftersurgeryincontrolgroup(P＞0.05).NofacialhypoesthesiaappearedinthepatientsreceivingMVD.5casesintheelderlyand2casesincontrolgroupunderwentpartialtrigeminalrhizotomywithfacialhypoesthesia,butthepainreleased,andnorecurrencewasfound.Therewerenodeadcasesinbothgroups.ConclusionsWithcautiousandpropertreatment,microsurgicalDOI:10.3760/cma.j.issn.0254-9026.2012.06.019作者单位：100730卫生部北京医院神经外科procedurecanbeperformedsafelyandeffectivelyintheelderlyTN.Trigeminalneuralgia;Microsurgery;Postoperativecomplications;Decompression,surgicalⅠ～Ⅱ级,As@@[1]SekulaRF,MarchanEM,FletcherLH,etal.Microvas...
