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| 三叉神经V3支术后疼痛复发的危险因素 |
| Risk factors for influencing postoperative recurrence of V3 branch of trigeminal nerve |
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| DOI：10.12089/jca.2022.07.007 |
| 中文关键词: 三叉神经痛 射频热凝术 球囊压迫术 下颌神经疼痛 |
| 英文关键词: Trigeminal neuralgia Radiofrequency Balloon compression Mandibular nerve pain |
| 基金项目:南通市科技局项目（MSZ18151）；嘉兴市科技局项目（2021AD30164） |
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| 中文摘要: |
目的 构建二元Logistic回归模型分析影响三叉神经V3支术后疼痛复发的危险因素。
方法 选择2016年2月至2020年9月接受CT引导下微创手术治疗的三叉神经V3支下颌神经疼痛患者123例，男50例，女73例，年龄34～94岁，ASA Ⅰ或Ⅱ级。采用疼痛数字评分（NRS）评价复发情况，以NRS较术前基线下降≥50%作为未复发的标准，以术后1年为观察点，通过电子病历系统收集性别、年龄、手术类型、有无合并症、有无既往手术史、术前疼痛分级和病程等指标。通过单因素分析筛选出P＜0.20的变量，采用双向逐步回归法进一步筛选对结局有重要贡献的变量，采用受试者工作曲线（ROC）对模型区分度进行评价以及采用校准曲线评估模型的校准度，并采用Brier得分量化校准度评估，绘制列线图预测个体复发风险。
结果 术后1年复发17例（13.8%），单因素分析结果显示，性别、年龄、手术类型和病程是术后1年复发的因素。多因素分析结果显示，年龄≥65岁（OR=6.843，95%CI 1.425～32.854，P=0.016）和病程≥5年（OR=4.002，95%CI 1.265～12.661，P=0.018）是影响术后1年复发的独立危险因素，而球囊压迫术（OR=0.195，95%CI 0.038～0.991，P=0.049）是术后1年复发率的保护性因素。
结论 年龄≥65岁、病程≥5年发生三叉神经V3支术后疼痛复发的风险相对更大，对于原发性三叉神经痛的患者，其手术方式的选择应充分考虑到不同术式的优缺点，应该合理选择治疗方案。 |
| 英文摘要: |
Objective To analyze the risk factors for recurrence of V3 branch of trigeminal nerve surgery by establishing a binary Logistic regression model.
Methods A total of 123 patients,50 males and 73 females, aged 34-94 years, ASA physical status Ⅰ or Ⅱ,with V3 branch of trigeminal nerve and mandibular nerve pain who received CT-guided minimally invasive surgery from February 2016 to September 2020 were selected. The recurrence was evaluated by the numerical pain score (NRS). The NRS decreased by ≥ 50% compared with the baseline before operation as the standard for no recurrence. One year after operation was set as the observation point, the indicators such as gender, age, type of operation, presence or absence of complications,previous operation history,preoperative pain grade and course of disease were counted using electronic medical record system. The variables with P < 0.20 were screened by univariate analysis, and the variables with important contribution to the outcome were further screened by two-way stepwise regression method. The receiver operating characteristic curve (ROC) was used to evaluate the degree of differentiation. Calibration curve was used to evaluate the calibration degree of the model, and Brier score was used to evaluate the calibration degree. Line segment nomograms were drawn to predict individual recurrence risk.
Results 17 pativents (13.8%) relapsed one year after surgery. Univariate logistic regression analysis showed that, age, sex, type of surgery and course of disease were factors for recurrence 1 year after surgery. Multivariate modeling results showed that age ≥ 65 years (OR = 6.843,95% CI 1.425-32.854, P=0.016) and course of disease ≥5 years (OR = 4.002, 95% CI 1.265-12.661, P=0.018) were independent risk factors for postoperative recurrence,and balloon compression (OR = 0.195,95% CI 0.038-0.991, P=0.049) was a protective factor affecting outcome.
Conclusion Patients older than 65 years and with a disease course of more than 5 years are more likely to have recurrence of trigeminal V3 branch pain after surgery. Patients with primary trigeminal neuralgia, the advantages and disadvantages of different surgical procedures should be fully considered,in order to choose the best treatment plan. |
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