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目的 ;研究伽玛刀治疗原发性三叉神经痛的最佳照射剂量。方法选择2004年1月~2010年3月期间经保守治疗无效的原发性三叉神经痛患者进行伽玛刀治疗。根据不同的照射剂量随机分为高剂量组(80~85Gy)和低剂量组(70~75 Gy),治疗后定期随访,进行疗效分析。结果本组总计65例患者,随访60例,失访5例,随访率92.3%,随访期12~78个月,平均随访期36个月。对两组共60例患者进行了统计学分析,其中高剂量组25例,低剂量组35例。高剂量组1例无效,有效率96%,低剂量组2例无效,有效率94.3%,两组有效率无差异(P>0.05)。高剂量组出现面部麻木17例,并发症发生率68%,低剂量组出现面部麻木7例,并发症发生率20%,两组并发症发生率有显著差异(P<0.05)。高剂量组治疗后疼痛完全缓解时间为2.51个月,低剂量组治疗后疼痛完全缓解时间为2.67个月,两组疼痛缓解时间无差异(P>0.05)。结论伽玛刀治疗原发性三叉神经痛安全有效,70~75 Gy应作为最佳照射剂量。
Objective To study the optimal dose of Gamma Knife for the treatment of primary trigeminal neuralgia. Methods Patients with primary trigeminal neuralgia who were ineffective in conservative treatment between January 2004 and March 2010 were treated with gamma knife. According to different irradiation doses, the patients were randomly divided into high dose group (80-85Gy) and low dose group (70-75Gy). Regular follow-up after treatment was performed to analyze the curative effect. Results A total of 65 patients were followed up in 60 cases and lost in 5 cases. The follow-up rate was 92.3%. The follow-up period was 12 to 78 months with an average follow-up period of 36 months. A total of 60 patients in both groups were analyzed statistically, including 25 cases in the high-dose group and 35 cases in the low-dose group. The high dose group was ineffective in one case, the effective rate was 96%. The low dose group was ineffective in two cases, the effective rate was 94.3%. There was no difference between the two groups (P> 0.05). There were 17 cases of facial numbness in high dose group, the complication rate was 68%. There were 7 cases of facial numbness in low dose group, the complication rate was 20%. There was significant difference between the two groups (P <0.05). The complete pain relief time was 2.51 months in the high-dose group, 2.67 months in the low-dose group, and no difference in pain relief time between the two groups (P> 0.05). Conclusion Gamma knife is safe and effective in the treatment of primary trigeminal neuralgia, and the optimal irradiation dose should be 70-75 Gy.