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題名:Percutaneous Trigeminal Ganglion Compression for Trigeminal Neuralgia     (16點)
以經皮膚三叉神經節汽球壓迫阻斷手術來治療三叉神經痛
著者:Jyi-Feng Chen(陳志豐) ;Shih-Tseng Lee(李石增)
出版地區:台灣
出版城市:台北市
學科:醫學綜合
關鍵字:trigeminal neuralgia ; percutaneous trigeminal ganglion compression
刊名:Formosan journal of surgery
卷期:42卷6期(2009.12)
頁碼:313-320
語言:英語
摘要: 中文摘要PDF ; 英文摘要PDF

經皮膚三叉神經節汽球壓迫阻斷手術於1983年首先山Mullan和Lichtor所提出。其主要適應對象?需接受外科手術治療三叉神經痛病患,包括接受其他手術後症狀復發的病患。而本科於1999年成功引進經皮膚三叉神經節汽球壓迫阻斷手術。由2000年6月至2001年6月,我們已順利地施行此一手術於100位三叉神經痛病患,其中男性46位;女性54位,年齡最大87歲;最小26歲,其中51位病患年齡在65歲或以上,其中有61位病患有眼支或多支的疼痛產生,1位病患?雙側三叉神經痛,且只接受一側手術。麻醉時間約?一小時,神經節壓迫時間?0到90秒。94位病患於第一次手術後疼痛立即解除,術後疼痛立即緩解率可高達94%。全部病患沒有因?麻醉而產生併發症,手術成功後,病患疼痛立即解除,取而代之的是持續性輕度到中度半側顏面麻木感和咀嚼肌力減弱情況,此情形絕大部分病患都能忍受,此種感覺麻木感和咀嚼肌力減弱情況大部分患者三個月後皆能獲得改善。無嚴重手術或麻醉併發症產生。除二位病患以門診手術方式治療外,其餘都住院手術治療。手術成功病患,在經過五年以上長期追蹤,結果發現術後二年內疼痛緩解率?86.2%,術後三年內疼痛緩解率?84%,整體而言,術後五年內疼痛緩解率?71.3%。 所以此一經皮膚三叉神經節氣球壓迫阻斷手術?治療三叉神經痛病患另一種手術選擇,雖然在手術技術上和麻醉技術上仍有需要特別注意之處。此一手術仍?一最安全且有效的手術,尤其是高危險群病患,和年長病患。且我們五年追蹤報告發現,此一手術有很高的手術成功率,其五年內疼痛緩解率與開顱手術相當,此一結果與國外其它中心報告相近似。
Objective: The aim of this study was to evaluate outcomes and complication rates associated with percutaneous trigeminal ganglion compression (PTGC), followed up for at least 5 years. Methods: The authors report on 100 cases of trigeminal neuralgia treated by percutaneous trigeminal ganglion compression from June 2000 to June 2001. The operation was performed under general anesthesia with endotracheal intubation. Meckel's cave was cannulated with No.4 Fogarty catheter and the balloon was inflated for 70 to 90 seconds. Results: A 5-year follow-up study was completed for all the 100 patients. Fifty-one patients (51%) were 65 years of age or above. Ninety-four patients (94%) were immediately relieved of their neuralgia after the procedure. Three patients had postoperative cheek hematoma. Thirty-three patients developed herpes simplex perioralis after the operation. Two patients had transient 6th nerve palsy, which subsided within 3 months. There were no major surgical complications, no anesthetic complications and no death. No pain recurred within 3 months. Thirteen patients (13.8%) had recurrent symptoms within 2 years. Fifteen patients (16%) had recurrent symptoms within 3 years. In all, 27 patients (28.7%) had recurrent symptoms over the entire 5-year study period. Conclusions: PTGC is a technically simple, relatively noninvasive procedure that can be carried out under brief general anesthesia. The patients can tolerate well the treatment. The procedure, at present, is the first choice for those trigeminal neuralgia patients who are poor medical risks, who are above the age of 65, and who are unwilling to accept the risk of a posterior fossa craniectomy.


    

本卷期目次
Formosan journal of surgery 42卷6期 (2009.12)
Genetic Variants Susceptibility to Breast Cancer/ Huan-Ming Hsu
The Use of Interbody Cage Devices in the Lumbosacral Spine/ Shih-Hao Chen
Percutaneous Trigeminal Ganglion Compression for Trigeminal Neuralgia/ Jyi-Feng ChenShih-Tseng Lee
Modified Percutaneous Dilatational Tracheostomy without Bronchoscopic Guidance Experience of 165 Consecutive Cases/ Ming-Ching LeeChung-Ping HsuWen-Ching Shin
Minimally Invasive Surgery for Adult Intussusception Caused by Primary Mucinous Adenocarcinoma of Jejunum: Report of a Case/ Ming-Jenn ChenYun-Sheng Tai
Sigmoid Colon Perforation Following Abdominal Aortic Aneurysm Surgery/ Wei-Lung TsengHsu-Hung TsengChiu-Yang Lee
Retroperitoneal Malignant Neoplasm with Perivascular Epithelioid Differentiation: Report of a Case/ Hui-Ting HsuPei LinKun-Tu YehChih-Jung Chen
Breast Carcinoma Metastasizing to Composite Pheochromocytoma: Report of a Case/ Ruey-Liang ChenMao-Ho LiuHsiao-Ping Wu
Solid Pseudopapillary Tumor of the Pancreas: Images for Surgeons/ Min-Hsiang HungJinn-Rung KuoYi-Ching HuangDing-Ping Sun
Comment on NOTES "Natural Orifice Transluminal Endoscopic Surgery-Transgastric and Transvaginal Biliary Endosurgery in a Porcine Model"/ Brian P. HungKuo-Cheng Shih
 
   
 
   

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