射频热凝术联合注射阿霉素治疗三叉神经下颌支痛的临床研究

doi:10.7518/hxkq.2022.04.012

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (4): 446-450.doi: 10.7518/hxkq.2022.04.012

射频热凝术联合注射阿霉素治疗三叉神经下颌支痛的临床研究

张玲阁¹(), 李洁²(), 李继宏¹, 汤宏超¹, 刘玉学³

^1.郑州市口腔医院口腔颌面外科，郑州 450000
^2.郑州市口腔医院正畸科，郑州 450000
^3.安阳市第六人民医院颌面外科，安阳 455000

收稿日期:2021-11-25 修回日期:2022-05-09 出版日期:2022-07-25 发布日期:2022-07-27
通讯作者: 李洁 E-mail:253485823@qq.com;364906344@qq.com
作者简介:张玲阁，副主任医师，硕士，E-mail：253485823@qq.com
基金资助:
河南省医学科技攻关计划联合共建项目(LHGJ2019-1151)

Radiofrequency thermocoagulation combined with doxorubicin injection for treatment of trigeminal neuralgia mandibular branch

Zhang Lingge¹(), Li Jie²(), Li Jihong¹, Tang Hongchao¹, Liu Yuxue³

^1.Dept. of Oral and Maxillofacial Surgery, Zhengzhou Stomatologic Hospital, Zhengzhou 450000, China
^2.Dept. of Orthodontics, Zhengzhou Stomatologic Hospital, Zhengzhou 450000, China
^3.Dept. of Oral and Maxillofacial Surgery, Anyang Sixth People’s Hospital, Anyang 455000, China

Received:2021-11-25 Revised:2022-05-09 Online:2022-07-25 Published:2022-07-27
Contact: Li Jie E-mail:253485823@qq.com;364906344@qq.com
Supported by:
Medical Science and Technology Research Plan Joint Construction Project in Henan Province(LHGJ20191151);Correspondence: Li Jie, E-mail: 364906344@qq.com

摘要/Abstract

摘要：

目的　评价3D打印模板引导射频热凝术联合注射阿霉素治疗三叉神经下颌支痛的临床应用价值。方法　将2019年1月—2020年9月在郑州市口腔医院接受射频热凝治疗的50例原发性三叉神经下颌支痛患者随机分为2组，以3D打印模板引导射频热凝术联合注射阿霉素为研究组（n=25），以3D打印模板单纯辅助射频热凝术为对照组（n=25），对比分析2组患者术前，术后即刻及术后1、3、6、12个月时的疼痛情况，即视觉模拟评分（VAS）。采用Brisman三叉神经疼痛疗效评定标准对术后各随访时间段的治疗效果进行评估，并记录术后并发症的情况。结果　2组患者术后即刻VAS及术后1、3、6、12个月时的VAS与术前比较均明显下降，差异均有统计学意义（P<0.05）；根据Brisman三叉神经痛疗效评定标准，2组患者在术后1和3个月时的有效性差异无统计学意义（P>0.05）；术后6和12个月时，研究组的有效性高于对照组，差异均有统计学意义（P<0.05）。研究组患者在随访期间无复发病例，对照组患者在术后3个月时复发1例，术后6个月时复发2例，术后12个月时复发4例；2组患者均未出现明显并发症。结论　3D打印模板引导射频热凝术联合注射阿霉素治疗三叉神经下颌支痛，可增强治疗的远期疗效，降低复发率，值得临床推广应用。

关键词: 3D打印模板, 射频热凝术, 阿霉素, 三叉神经痛, 下颌支

Abstract:

Objective This study aimed to evaluate the clinical application value of 3D printed template-guided radiofrequency thermocoagulation combined with doxorubicin injection for the treatment of trigeminal neuralgia mandibular branch. Methods A total of 50 patients with primary trigeminal neuralgia mandibular branch in the hospital from January 2019 to September 2020 were randomly divided into two groups: 3D printed template-guided radiofrequency thermocoagulation combined with doxorubicin injection was used as the research group (n=25), and 3D printed template guided radiofrequency thermocoagulation was used as the control group (n=25). Comparative analysis of visual analogue score (VAS) was conducted before and immediately after surgery and at 1, 3, 6, and 12 months after surgery. The Brisman efficacy evaluation criteria for trigeminal neuralgia was used to evaluate the therapeutic effect of each postoperative follow-up period, and postoperative complications were observed. Results The VAS immediately after surgery and at 1, 3, 6, and 12 months after surgery in the two groups was significantly lower than that before surgery, with statistical significance (P<0.05). According to Brisman efficacy evaluation criteria for trigeminal neuralgia, no significant difference was found in the efficacy between the two groups at 1 and 3 months after surgery (P>0.05). At 6 and 12 months postoperatively, the effectiveness of the research group was higher than that of the control group, and the differences were statistically significant (P<0.05). In the research group, no recurrence occurred during the follow-up period, whereas in the control group, one, two, and four recurrences occurred 3, 6, and 12 months after surgery, respectively. No obvious complications were found in both groups. Conclusion 3D printed template-guided radiofrequency thermocoagulation combined with doxorubicin injection for the treatment of trigeminal neuralgia mandibular branch could enhance the long-term curative effect and reduce the recurrence rate, thus worthy of clinical promotion and application.

Key words: 3D printed template, radiofrequency thermocoagulation, doxorubicin, trigeminal neuralgia, mandibular branch

中图分类号:

R 782

张玲阁, 李洁, 李继宏, 汤宏超, 刘玉学. 射频热凝术联合注射阿霉素治疗三叉神经下颌支痛的临床研究[J]. 华西口腔医学杂志, 2022, 40(4): 446-450.

Zhang Lingge, Li Jie, Li Jihong, Tang Hongchao, Liu Yuxue. Radiofrequency thermocoagulation combined with doxorubicin injection for treatment of trigeminal neuralgia mandibular branch[J]. West China Journal of Stomatology, 2022, 40(4): 446-450.

图/表 4

图 1

表 1

表 2

2组不同治疗时段VAS比较 (n=25，xˉ±s)

组别	术前	术后即刻	术后1个月	术后3个月	术后6个月	术后12个月
研究组	8.17±0.72	2.60±0.91 $*$	2.87±1.25 $*$	2.40±0.91*	2.20±0.86 $*$	2.07±0.70 $*$
对照组	8.25±0.87	3.07±0.96*	3.27±1.22 $*$	3.00±1.00 $*$	2.73±0.96 $*$	2.47±0.83 $*$

表 2

表 3

参考文献 13

1	廖翔, 蒋劲, 熊东林, 等. 经侧方入路与经卵圆孔三叉神经下颌支介入射频热凝术的临床比较[J]. 中国疼痛医学杂志, 2011, 17(4): 218-221.
	Liao X, Jiang J, Xiong DL, et al. Clinical comparison of radiofrequency thermocoagulation treatment of mandibular nerve via lateral approach or through foramen ovale in patients with primary trigeminal neuralgia[J]. Chin J Pain Med, 2011, 17(4): 218-221.
2	杨茂林, 梁琳, 范向凯. 射频热凝联合阿霉素用于原发性三叉神经痛治疗的临床研究[J]. 山西医科大学学报, 2018, 49(6): 678-681.
	Yang ML, Liang L, Fan XK. Clinical study of radiofrequency thermocoagulation combined with pirarubicin in the treatment of idiopathic trigeminal neuralgia[J]. J Shanxi Med Univ, 2018, 49(6): 678-681.
3	Brisman R. Gama knife radiosurgery for primary ma⁃nagement for trigeminal neuralgia[J]. J Neurosurg, 2000, 93(): 159-161.
4	黄冰, 陈雅静, 谢可越, 等. 三叉神经痛的颅外非半月节射频治疗进展[J]. 中国疼痛医学杂志, 2019, 25(5): 374-377, 382.
	Huang B, Chen YJ, Xie KY, et al. Advances in radiofrequency treatment of extracranial non-meniscus ganglia for trigeminal neuralgia[J]. Chin J Pain Med, 2019, 25(5): 374-377, 382.
5	Erbagci H, Kizilkan N, Sirikci A, et al. Computed tomography based measurement of the dimensions of foramen ovale and rotundum in trigeminal neuralgia[J]. Neurosciences (Riyadh), 2010, 15(2): 101-104.
6	邓滨, 欧阳汉斌, 黄文华. 3D打印在医学领域的应用进展[J]. 中国医学物理学杂志, 2016, 33(4): 389-392.
	Deng B, Ou-Yang HB, Huang WH. Application progress of three-dimensional printing in medical field[J]. Chin J Med Phys, 2016, 33(4): 389-392.
7	张玲阁, 邓末宏, 龙星, 等. 3D打印导板辅助射频温控热凝术治疗第2支三叉神经痛的临床研究[J]. 华西口腔医学杂志, 2018, 36(6): 662-666.
	Zhang LG, Deng MH, Long X, et al. 3D printing navigation template-guided percutaneous radiofrequency thermocoagulation for V2 trigeminal neuralgia treatment[J]. West China J Stomatol, 2018, 36(6): 662-666.
8	Wu SN, So EC, Liao YK, et al. Reversal by ranolazine of doxorubicin-induced prolongation in the inactivation of late sodium current in rat dorsal root ganglion neurons[J]. Pain Med, 2015, 16(5): 1032-1034.
9	许小燕, 张永福. 阿霉素神经干内注射治疗原发性三叉神经痛285例临床分析[J]. 中国口腔颌面外科杂志, 2013, 11(2): 158-160.
	Xu XY, Zhang YF. Evaluation of the clinical therapeutic efficacy by injecting adriamycin into the affected neural branches in 285 patients with primary trigeminal neuralgia[J]. China J Oral Maxillofac Surg, 2013, 11(2): 158-160.
10	顾峰杰, 张志良. 热射凝复合阿霉素介入治疗三叉神经痛的临床疗效观察[J]. 现代中西医结合杂志, 2016, 25(30): 3396-3398, 3399.
	Gu FJ, Zhang ZL. Observation on the clinical effect of thermal injection combined with adriamycin in interventional treatment of trigeminal neuralgia[J]. Modern J Integr Tradit Chin Western Med, 2016, 25(30): 3396-3399.
11	孙倩倩, 罗伟, 徐霞, 等. 射频联合表柔比星注射治疗复发性三叉神经痛的疗效研究[J]. 中国疼痛医学杂志, 2020, 26(6): 451-454.
	Sun QQ, Luo W, Xu X, et al. Efficacy of radiofrequency combined with epirubicin injection in the treatment of recurrent trigeminal neuralgia[J]. Chin J Pain Med, 2020, 26(6): 451-454.
12	李雷州, 刘玉学, 牛瑞堂, 等. CT引导下三叉神经周围支射频热凝术联合阿霉素介入治疗原发性三叉神经痛[J]. 中国临床神经外科杂志, 2018, 23(10): 673-675.
	Li LZ, Liu YX, Niu RT, et al. Interventional treatment of idiopathic trigeminal neuralgia with radiofrequency thermocoagulation combined with adriamycin under CT gui-dance[J]. Chin J Clin Neurosurg, 2018, 23(10): 673-675.
13	任长和. 阿霉素的神经毒性及其在带状疱疹后神经痛中的应用[J]. 西南医科大学学报, 2019, 42(3): 293-297.
	Ren CH. Neurotoxicity of adriamycin and its application in postherpetic neuralgia[J]. J Southwest Med Univ, 2019, 42(3): 293-297.

组别	男/女（n）	年龄	病程	术前VAS
研究组	9/16	60.30±6.53	6.66±4.17	8.17±0.72
对照组	8/17	62.60±9.40	6.83±4.47	8.25±0.87
	0.089	0.552	0.097	0.318
P值	0.765	0.595	0.925	0.758

[1]	卢妍竹, 张婧琦, 赖文莉. 大鼠三叉神经痛模型中小胶质细胞激活情况及经时变化[J]. 华西口腔医学杂志, 2022, 40(6): 638-644.
[2]	祝颂松, 王旭东, 杨学文, 王晓霞, 田磊, 刘曙光, 郑广森, 唐正龙, 吴国民, 李志勇, 白晓峰, 黄旋平, 黄立, 习伟宏, 朱耀旻. 下颌支矢状骨劈开术并发症防治的专家共识[J]. 华西口腔医学杂志, 2022, 40(3): 247-254.
[3]	张玲阁,邓末宏,龙星,王章正. 3D打印导板辅助射频温控热凝术治疗第2支三叉神经痛的临床研究[J]. 华西口腔医学杂志, 2018, 36(6): 662-666.
[4]	秦泗佳1,2 张晓红2 金海威2 高璐2 王福2. 大鼠三叉神经痛模型中痛阈及胶质细胞源性神经营养因子的变化[J]. 华西口腔医学杂志, 2015, 33(1): 16-20.
[5]	张霞白晓峰张倩 . 三叉神经痛大鼠中钙通道α2δ-1亚单位表达的变化[J]. 华西口腔医学杂志, 2012, 30(3): 314-316.
[6]	胡晓文黄洪章余东升. 阿霉素诱导鸟嘌呤-四链体形成对Tca8113细胞端粒酶介导的端粒延伸反应的影响[J]. 华西口腔医学杂志, 2007, 25(04): 399-403.
[7]	黄翠姣;王虎;吴明月;张京剧;孟庆荣;付春华;邓建中;易平. 雌激素受体基因多态性与三叉神经痛的相关性研究[J]. 华西口腔医学杂志, 2005, 23(06): 495-497.
[8]	张洪,张茜蕾,魏云,李森,张正健,任万武. 颞乳突开窗内窥镜桥脑小脑角三叉神经手术[J]. 华西口腔医学杂志, 2004, 22(02): 168-168.
[9]	赵云富　姜晓钟　刘渊　胡世辉　宋朝佑. 三叉神经痛患者血浆血管活性肠肽的观察[J]. 华西口腔医学杂志, 2002, 20(01): 33-34.
[10]	陈佐华,赵宗林,李明哲,杨永沛. 三种径路射频热凝术治疗原发性三叉神经痛疗效分析[J]. 华西口腔医学杂志, 2001, 19(04): 240-242.
[11]	于殿绅,王大章. 下颌升支斜行骨切开术后血管系统重建立体形态构筑的实验研究[J]. , 1998, 16(04): 0-.
[12]	谢君玉，刘伟，刘文修，尧茂江，柏敏，杨介平. 原发性三叉神经二、三支疼痛高位切除术的临床报告[J]. , 1995, 13(03): 0-.

射频热凝术联合注射阿霉素治疗三叉神经下颌支痛的临床研究

Radiofrequency thermocoagulation combined with doxorubicin injection for treatment of trigeminal neuralgia mandibular branch

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组别	术后1个月				术后3个月				术后6个月				术后12个月
组别	治愈	显效	有效	无效	治愈	显效	有效	无效	治愈	显效	有效	无效	治愈	显效	有效	无效
研究组	24	1	0	0	23	0	2	0	23	2	0	0	24	1	0	0
对照组	22	1	2	0	20	1	3	1	19	0	4	2	17	1	3	4