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| 三种不同显微血管减压技术治疗面肌痉挛患者的经验浅析 |
| Experience analysis of three different microvascular decompression techniques for the treatment of hemifacial spasm patients |
| 投稿时间：2024-05-22 修订日期：2024-05-22 |
| DOI： |
| 中文关键词: 面肌痉挛 显微血管减压术 责任血管 面部痉挛程度 面神经功能 治疗效果 听神经功能 复发 |
| 英文关键词: Facial spasm Microvascular decompression Responsible blood vessels Degree of facial spasms Facial nerve function Therapeutic effect Auditory nerve function Recrudescence |
| 基金项目:2019 年四川省医学（青年创新） 科研课题（S19070） |
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| 中文摘要: |
| 目的：通过临床实际案例治疗经验分析三种不同显微血管减压（MVD）技术治疗面肌痉挛（HFS）患者的效果与安全性，以便为临床提供相关参考依据。方法：选取我院2020年5月至2022年12月114例HFS患者，随机数字表法分为3组，各38例。3组均行MVD，全程减压组术中行面神经全程减压、中枢减压组术中行面神经中枢段减压，监测减压组术中于神经电生理监测下行面神经中枢段减压。比较3组治疗效果、手术相关指标、手术前后面部痉挛程度、面神经功能[House-Brackmann面神经功能（H-B）分级、sunnybrook面神经评分（SFGS）]、听神经功能[潜伏期、波间期、波幅脑干听觉诱发电位（BAEP）]、并发症发生率及复发率。结果：监测减压组、中枢减压组总有效率高于全程减压组（P＜0.05）；监测减压组手术时间、术中出血量、住院时间＜中枢减压组＜全程减压组（P＜0.05）；术后3个月、12个月监测减压组面部痉挛程度优于中枢减压组、全程减压组（P＜0.05）；监测减压组术后3个月、12个月面神经功能H-B分级＜中枢减压组＜全程减压组，SFGS评分＞中枢减压组＞全程减压组（P＜0.05）；监测减压组术后3个月、12个月BAEP潜伏期、波间期、波幅＞中枢减压组＞全程减压组（P＜0.05）；监测减压组、中枢减压组并发症发生率低于全程减压组（P＜0.05）；3组复发率差异无统计学意义（P＞0.05）。结论：MVD治疗HFS的过程中在进行面神经中枢段减压，能优化手术流程，促进病情恢复，增强临床效果，改善患者预后，尤其是在神经电生理监测下进行减压效果更加显著。 |
| 英文摘要: |
| Objective To analyze the efficacy and safety of three different microvascular decompression (MVD) techniques for the treatment of hemifacial spasm (HFS) patients through clinical case studies, in order to provide relevant reference for clinical practice. Methods A total of
114 patients with HFS were selected from May 2020 to December 2022 in our hospital and divided into 3 groups of 38 patients each by randomized numerical table method. MVD was performed in all the 3 groups. Total decompression group underwent total facial nerve decompression during operation, central decompression group underwent central facial nerve segment decompression during operation, and monitoring decompression group underwent central facial nerve segment decompression under neuroelectrophysiological monitoring. Compare the treatment effect, surgical related indexes of the 3 groups, as well as degree of facial spasm, facial nerve function [House-Brackmann facial nerve function (H-B) grade, sunnybrook facial nerve score (SFGS)], auditory nerve function [latency, wave interval, amplitude brainstem auditory evoked potential (BAEP)], complication rate and recurrence rate before and after surgery. Results The total effective rate of monitoring decompression group and central decompression group was higher than that of whole decompression group (P < 0.05). Operation time, intraoperative blood loss and hospital stay in decompression group were monitored < central decompression group < whole decompression group (P < 0.05); The degree of facial spasm in the monitoring decompression group at 3 months and 12 months after surgery was better than that in the central decompression group and the whole decompression group (P < 0.05). H-B classification of facial nerve function in decompression group < central decompression group < total decompression group, SFGS score > central decompression group > total decompression group at 3 and 12 months after surgery (P < 0.05); BAEP latency, wave interval and wave amplitude in decompression group were > central decompression group > whole decompression group at 3 and 12 months after surgery (P < 0.05). The complication rate of monitoring decompression group and central decompression group was lower than that of whole decompression group (P < 0.05). There was no significant difference in recurrence rate among the three groups (P > 0.05). Conclusion Controlled decompression in the treatment of HFS by MVD can optimize the surgical process, promote the recovery of the disease, enhance the clinical effect and improve the prognosis of patients, especially the effect of monitored controlled decompression is more significant. |
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