三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

原发性三叉神经痛微血管减压术后复发的相关因素分析

目的探讨原发性三叉神经痛病人经微血管减压术(microvascular decompression,MVD)治疗后复发的危险因素。方法回顾性分析261例经MVD手术的原发性三叉神经痛病人的临床资料。行单因素卡方检验和Logistic多因素回归分析术后复发的独立危险因素。结果本组原发性三叉神经痛总复发率为14.9%。单因素分析结果显示:性别、血管压迫程度、责任血管类型、术前磁共振断层血管成像(magnetic resonance tomographic angiography,MRTA)检查是否有血管压迫、术中是否使用神经内镜辅助及Teflon棉片使用方法与术后复发具有相关性(P<0.05)。多因素Logistic回归分析显示:女性、血管压迫程度(无压迫和重度压迫)、静脉及无血管压迫、术前MRTA检查无明显血管压迫是术后复发的独立危险因素,而Teflon棉絮包绕法是保护因素(P<0.05)。结论术前MRTA检查结果有利于判断预后;术中采用Teflon棉絮包绕法分离神经血管接触可减少术后复发;对无明显责任血管压迫者,建议行三叉神经感觉根切断术。     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

三叉神经痛合并根区蛛网膜粘连的病毒病因学研究

目的 探讨原发性三叉神经痛(TN)合并根区蛛网膜粘连与HSV-1感染的关系.方法 对TN患者于显微血管减压术中见其三叉神经根区合并蛛网膜粘连者59例,取其蛛网膜作为实验组;未合并根区明显蛛网膜粘连的TN患者24例,取其蛛网膜作为病例对照组;采用PCR和Western Blot方法分别检测其HSV-1特异性DNA片段、特异性抗原,并以20例外伤患者蛛网膜做正常对照.结果 三组资料中DNA片段阳性率分别为:69%、58%和25%;实验组和病例对照组的DNA片段阳性率均高于正常对照组,且差异有统计学意义(P＜0.05),但实验组和病例对照组相比差异无统计学意义(P＞0.05);病毒特异性抗原阳性率分别为:51%、25%和15%,实验组病毒抗原阳性率高于病例对照组,也高于正常对照组,差异有统计学意义(P＜0.05),而病例对照组和正常对照组相比差异无统计学意义(P＞0.05).结论 HSV-1病毒增殖性感染可能促使TN患者三叉神经根区蛛网膜的粘连,蛛网膜组织可能是HSV-1潜伏感染的另一基地;HSV-1病毒感染可能是TN又一致病因素.

Abstract：

Objective To assess the relationship that trigeminal neuralgia combining arachnoids' adhesions and herpes simplex virus type 1. Methods There are fifty nine patients with trigeminal neuralgia their trigeminal nerve root area combined arachnoids' adhesion, cutting their arachnoids as the experimental group. There are twenty four patients with trigeminal neuralgia their trigeminal nerve root area is not combined significant arachnoids' adhesion, cutting their arachnoids as the case - control group. Using polymerase chain reaction and Western blot technique to detecting the HSV - 1 specific DNA fragments and specific antigen,and cutting twenty arachnoids of the patients with Brain Trauma as the normal control group. Results The positive ratio of DNA fragments in the three group is 69% 、58% and 25% respectively. The positive ratio of DNA fragments in the experiment group and case -control group were higher than the normal control group,with statistical difference ( P ＜ 0. 05 ), but the experimental group and case -control group compared with no significant difference ( P ＞ 0. 05 ). The positive ratio of virus - specific antigen is 51%、 25 % and 15 %respectively. The positive ratio of virus - specific antigen was higher than the case - control group, also higher than the normal control group, were significantly different ( P ＜ 0. 05 ), while the case - control group and the normal control group compared with no significant differences ( P ＞ 0. 05 ). Conclusion HSV - 1 proliferating infected patients with trigeminal neuralgia may result in the arachnoids adhesion of trigeminal nerve root zone; arachnoids tissue may be another latent base of HSV - 1; HSV - 1 infection may be another pathogenic factor of trigeminal neuralgia.     

破裂前交通动脉动脉瘤夹闭术中动脉瘤再次破裂病人预后 不良的危险因素

目的 探讨破裂前交通动脉动脉瘤夹闭术中动脉瘤再次破裂病人预后的危险因素。方法 回顾性分析2014年1月至2017年10月开颅夹闭术治疗的90例破裂前交通动脉动脉瘤术中发生再次破裂病人的临床资料。术后随访12个月,按GOS评分评估预后,1~3分为预后不良,4~5分为预后良好。采用多因素Logistic回归分析检验预后不良危险因素。结果 90例中,预后良好69例,预后不良21例。多因素Logistic回归分析结果显示,动脉瘤直径≥7 mm、术前Hunt-Hess分级Ⅲ级、术中应用临时阻断夹、破裂位于瘤颈部、合并脑水肿及术后未腰大池引流为预后不良的独立危险因素（P<0.05）。结论 破裂前交通动脉动脉瘤夹闭术中动脉瘤再次破裂病人预后不良的危险因素很多,临床应及早处理,以便改善病人预后。     

依达拉奉治疗急性重型颅脑损伤的疗效观察

目的观察依达拉奉对重型颅脑损伤的治疗效果。方法 80例急性重型颅脑损伤病人按随机数字表随机分成依达拉奉全量治疗组32例,依达拉奉减量治疗组28例,对照组20例。治疗14d后,观察分析GCS评分及不良反应。结果与对照组相比,依达拉奉全量治疗组和减量治疗组GCS评分明显升高(P0.05),但两组间GCS评分差异无显著性。结论早期应用依达拉奉治疗急性重型颅脑损伤有较好的效果,且副作用少,安全可靠。     

脑胶质瘤术后超选介入化疗联合系统化疗的临床研究

目的 探讨术后超选择介入化疗联合系统化疗治疗脑胶质瘤的优势.方法 2006年至2009年山东济宁市第一人民医院介入科收治46例腩胶质瘤的患者.据患者自愿入组的原则分为两组.治疗组:25例患者手术后先行常规放疗,然后行超选介入化疗,同期进行系统化疗.对照组:21例患者手术后先行常规放疗,然后只进行系统化疗.定期随访,复查颅脑CT,测量肿瘤的体积,并进行Karnofsky预后评分.比较肿瘤体积变化及两组间Karnofsky预后评分的差异.结果 平均随访2.3年,两组均无死亡病例.化疗前两组肿瘤的体积差异无统计学意义,(P>0.05).化疗1年后介入化疗联合系统化疗组肿瘤缩小率为67.11%,系统化疗组肿瘤缩小率为45.79%,两组肿瘤体积经独立样本t检验显示肿瘤体积差异有统计学意义(P<0.05).治疗组在化疗期间出现癫痫3例,眼痛5例,头痛9例,恶心呕吐8例,血小板下降1例.对照组出现癫痫1例,头痛7例,血小板下降3例,恶心呕吐6例.Wilcoxon秩和检验Karnofsky预后评分显示介入化疗结合系统化疗组的预后优于单纯系统化疗组.(P<0.05).结论 术后放疗结合介入化疗联合系统化疗的治疗方法,与术后放疗结合系统化疗的治疗方法相比,可以更有效的控制肿瘤的生长,改善临床症状,提高生活质量,是值得进一步探讨的化疗方法.     

三叉神经根区周围蛛网膜粘连与HSV-1感染关系的实验研究

目的 研究三叉神经痛患者三叉神经根区周围蛛网膜粘连与单纯疱疹病毒Ⅰ型感染的关系.方法 实验组40 例三叉神经痛患者三叉神经根区粘连的蛛网膜,对照组20 例外伤患者蛛网膜,每例蛛网膜分别做病理切片,PCR 检测HSV-1 特异性基因片段以及用HSV-1 单克隆抗体检测抗原的表达.结果 实验组病理切片光镜下粘连的蛛网膜主要以炎细胞浸润、水肿、钙化以及粘液样变性为主,检测到HSV-1 特异性基因片段阳性率为72.5% (29 /40),抗原阳性率为17.5% (7 /40),即以潜伏感染为主,少部分呈增值性感染.对照组病理切片有3 例细胞轻度水肿,余均为正常蛛网膜结构.有4 例HSV-1 特异性基因片段阳性,无抗原阳表达.卡方检验实验组和对照组蛛网膜HSV-1 的感染率有统计学差异(P＜0.05).结论 三叉神经根区蛛网膜的粘连与HSV-1 的感染密切相关;粘连的蛛网膜加剧了根区动脉对三叉神经根的压迫,是加重三叉神经痛的病因之一.     

神经内镜在面肌痉挛微血管减压术中的应用研究

目的 探讨神经内镜在显微血管减压术(MVD)治疗面肌痉挛(HFS)的应用价值.方法 济宁市第一人民医院神经外二科自2006年12月至2009年12月应用神经内窥镜辅助下MVD治疗HFS患者118例,回顾性分析患者的临床资料和疗效.结果 术中单纯经显微镜下发现责任血管的共106例(89.83%),其中有7例患者在神经内镜辅助下再次发现其它责任血管压迫;8例(6.78%)在显微镜下未见明显血管压迫,但经神经内镜发现有责任血管的存在.显微镜下减压完成后再用神经内镜观察,发现Teflon棉片未减压完全,需再次调整的17例(14.41%);术后102例(86.44%)痉挛立即消失,11例(9.32%)逐渐消失,3例(2.54%)部分缓解,2例(1.70%)无明显减轻,轻度复发.无脑脊液漏、偏瘫、死亡等严重并发症发生.结论 神经内窥镜辅助下的MVD能清晰显示神经血管的解剖关系,减少对脑干、各颅神经的牵拉和重要血管的损伤,对提高手术疗效、减少复发率和术后并发症有重要价值.

Abstract：

Objective To explore the value ofneuroendoscope in microvascular decompression for treatment of primary hemifacial spasm. Methods One hundred and eighteen patients with hemifacial spasm, admitted to our hospital from December 2006 to December 2009, underwent endoscope-assisted microvascular decompression via suboccipital retrosigmoid approach; their clinical data and treatment efficacy were retrospectively analyzed. Results The offending vessels were found in 106 patients (89.83%) under microscope, of which 7 (5.93%) were again found other offending vessels under neuroendoscope. Eight patients (6.78%) were noted as no significant vascular compression under microscope, but the offending vessels of these patients existed under endoscope. Seventeen patients performed decompression with Teflon cotton under microscope needed modification when they were checked under endoscope. The symptoms of 102 patients (86.44%) disappeared immediately after the operation; 11 (9.32%) disappeared gradually; 3 (2.54%) had partial remission and 2 (1.70%) had no significantly remission. No serious complications, including cerebrospinal leakage, paralysis and death, were noted. Conclusion Endoscope-assisted microvascular decompression, by improving the observation of the anatomic neurovascular relation, decreasing the damage to the brain stem, nerves and important vessels, can improve the surgical treatment, and reduce the recurrence rate and postoperative complications.