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目的探讨射波刀对原发性三叉神经痛的临床治疗效果。方法随机选取解放军第一一七医院2013年7月—2014年7月收治的80例原发性三叉神经痛患者作为研究对象,采用数字法随机分为2组,每组各40例,所有患者治疗前均进行CT或MRI检查,排除脑部肿瘤对治疗效果的影响。对照组采用伽马刀治疗,研究组采用射波刀治疗,靶点位置为三叉神经根入桥脑段前2.5 mm处,准直器标准为4 mm,剂量曲线区间为70%~90%,中心剂量为66.50~84.25 Gy,边缘剂量为60~66 Gy,靶点大小为4.0 mm×3.0 mm,4.0×(3.7~5.0)mm~2。治疗后随访12个月,对比分析2组患者的临床治疗效果及二次治疗发生率。结果研究组的治疗总有效率为90.0%,对照组治疗总有效率为87.5%,组间对比差异不具有统计学意义(P>0.05)。治疗后随访12个月,研究组2例靶点确定不精确,经CT脑池造影重新确定靶点,进行二次治疗,二次治疗率为5%,对照组4例进行二次治疗,二次治疗率为10.0%,研究组二次治疗率略低于对照组,但差异无统计学意义(P>0.05)。结论与伽马刀相比,射波刀对原发性三叉神经痛的临床治疗效果较为明显,适合于临床推广使用。
Objective To investigate the clinical effect of radiosurgery on primary trigeminal neuralgia. Methods Totally 80 patients with primary trigeminal neuralgia admitted to the 117th Hospital of PLA from July 2013 to July 2014 were randomly divided into 2 groups (n = 40 in each group) and all patients Before treatment, CT or MRI were performed to exclude the influence of brain tumor on the treatment effect. The control group was treated with Gamma Knife. The study group was treated with radiosurgery. The target location was 2.5 mm anterior to the brain segment of the trigeminal nerve root, the standard collimator was 4 mm, the dose curve range was 70% -90% The center dose was 66.50-84.25 Gy, the edge dose was 60-66 Gy, and the target size was 4.0 mm × 3.0 mm and 4.0 × (3.7-5.0) mm ~ 2. The patients were followed up for 12 months. The clinical effects and the incidence of secondary treatment in two groups were compared. Results The total effective rate of the study group was 90.0%, while that of the control group was 87.5%. There was no significant difference between the two groups (P> 0.05). After 12 months of follow-up, the target of 2 cases in the study group was inaccurate. The targets were re-determined by CT brain pool angiography. The second treatment was 5%, while in the control group, 4 cases were treated secondarily. The second treatment rate was 10.0%. The second treatment rate in the study group was slightly lower than that in the control group, but the difference was not statistically significant (P> 0.05). Conclusion Compared with Gamma Knife, the radiotherapy knife is more effective in clinical treatment of primary trigeminal neuralgia and is suitable for clinical use.