伽玛刀单靶点治疗原发性顽固性三叉神经痛:73例随访观察

目的:评价伽玛刀单一靶点治疗顽固性三叉神经痛的疗效、安全性,以期为改善三叉神经痛患者的身心健康及生活质量提供干预方向。方法:回顾性分析1995-07/2003-06本院接受伽玛刀治疗的三叉神经痛患者73例,其中男31例,女42例,年龄35～79岁,平均61岁。病程1.5～29年,平均4.5年。所有的病例均设置单一靶点治疗,靶点部位选择在三叉神经入桥脑处,中心剂量70～90Gy,准直器为4mm。结果:伽玛刀治疗后全部患者在24h出院,出院后随访时间6～68个月不等,平均随访时间36.7个月。术后18例显效(24.7%),46例有效(63%),9例无效(12.3%)。症状缓解时间为2周～6个月,平均为3.5个月。治疗后症状复发6例,给予二次治疗,3例症状缓解,3例症状无变化。治疗后出现头痛呕吐反应3例,全部于1周后消失;面部麻木7例,无咀嚼肌运动障碍及角膜发干或溃疡发生。结论:伽吗刀治疗三叉神经痛安全、有效,能显著的缓解患者的疼痛,提高其生活质量。     

影响原发性三叉神经痛伽玛刀治疗效果的相关因素分析

目的探讨伽玛刀治疗原发性三叉神经痛的疗效及影响预后的因素。方法回顾性分析75例原发性三叉神经痛的患者行伽玛刀治疗的效果,均经OUR-XGD旋转式伽玛刀治疗,采用4—8mm准直器,半月节照射采用多靶点,三叉神经根照射采用单靶点或双靶点,中心剂量70—90Gy,脑干表面受量〈15Gy。通过随访患者疼痛发作的频率和程度的减轻评价疗效。结果随访时间为3～72个月,平均37．6个月,总有效率90．7％。4例患者2～3年后复发,6例在伽玛刀治疗后半年出现患侧面部麻木感,无其他并发症。经统计学分析,某些因素与疗效相关。结论伽玛刀治疗原发性三叉神经痛一种安全有效的方法,靶点选择、剂量选择、照射部位是影响预后的因素,而病史长短及疼痛分布与预后无相关性。     

伽玛刀单靶点治疗原发性顽固性三叉神经痛：73例随访观察

目的：评价伽玛刀单一靶点治疗顽固性三叉神经痛的疗效、安全性，以期为改善三叉神经痛患者的身心健康及生活质量提供干预方向。方法：回顾性分析1995-07／2003-06本院接受伽玛刀治疗的三叉神经痛患者73例，其中男31例，女42例，年龄35～79岁，平均61岁。病程1．5～29年，平均4．5年。所有的病例均设置单一靶点治疗，靶点部位选择在三叉神经入桥脑处，中心剂量70～90Gy，准直器为4mm。结果：伽玛刀治疗后全部患者在24h出院，出院后随访时间6～68个月不等，平均随访时间36．7个月。术后18例显效(24．7％)，46例有效(63％)，9例无效(12．3％)。症状缓解时间为2周～6个月，平均为3．5个月。治疗后症状复发6例，给予二次治疗，3例症状缓解，3例症状无变化。治疗后出现头痛呕吐反应3例，全部于1周后消失；面部麻木7例，无咀嚼肌运动障碍及角膜发干或溃疡发生。结论：伽吗刀治疗三叉神经痛安全、有效，能显著的缓解患者的疼痛，提高其生活质量。     

原发性三叉神经痛的再次伽玛刀治疗

目的:分析原发性三叉神经痛患者接受再次伽玛刀治疗的临床疗效、复发及并发症情况。方法:选取自1995年9月至2009年12月,52例首次伽玛刀治疗无效或复发的原发性三叉神经痛患者进行了再次伽玛刀治疗。再次治疗中心剂量为70⁸0 Gy,平均77.2 Gy。再次治疗靶点位置较首次治疗前移,两次治疗容积叠加约50%。本组采用巴罗神经学研究所(Barrow Neurological Institute,BNI)三叉神经痛评分标准对疗效进行了评估。结果:本组随访从治疗后1个月开始,随访平均时间为58个月。本组治疗有效46例,包括BNIⅠ级22例,BNIⅡ级14例,BNIⅢ级10例,总有效率为88.5%(46/52)。5例患者在治疗后680 Gy,平均77.2 Gy。再次治疗靶点位置较首次治疗前移,两次治疗容积叠加约50%。本组采用巴罗神经学研究所(Barrow Neurological Institute,BNI)三叉神经痛评分标准对疗效进行了评估。结果:本组随访从治疗后1个月开始,随访平均时间为58个月。本组治疗有效46例,包括BNIⅠ级22例,BNIⅡ级14例,BNIⅢ级10例,总有效率为88.5%(46/52)。5例患者在治疗后6⁷2个月出现复发,复发率为10.9%(5/46)。本组病例治疗后出现面部麻木者10例、面部感觉异常者2例,并发症发生率为23.1%(12/52)。结论:再次伽玛刀治疗安全有效,可以作为首次治疗无效或复发原发性三叉神经痛患者的可靠治疗方法之一。     

原发性三叉神经痛伽玛刀放射外科治疗的有效性评估

目的:评价伽玛刀放射外科治疗原发性三叉神经痛的安全性、有效性和心理状态。方法:2004年8月~2010年9月,98例经药物和其他方法治疗无效的原发性三叉神经痛患者接受伽玛刀放射外科治疗。放射剂量中位值是80 Gy(75~85 Gy)。采用患者自我报告疼痛的控制、生活满意度指数A(1ife satisfaction index A,LSI-A)的变化进行疗效评估。结果:治疗后89例(90.8%)患者获得随访,平均随访期35个月(13~60个月)。本组病例中治愈51例(57.3%);显效19例(21.3%);有效11例(12.4%);无效8例(9%),总有效率为91%;伽玛刀治疗后LSI-A总分平均值(36.25±3.87)高于治疗前(25.67±3.5);其中67例以往未接受过手术治疗患者中62例获得随访,58例有效,总有效率为93.5%。11例患者感觉患侧面部麻胀感,1例(二次治疗者)张口轻度受限。结论:伽玛刀放射外科治疗三叉神经痛显著缓解疼痛,提高生存质量。     

伽玛刀治疗原发性三叉神经痛疗效观察

目的 探讨伽玛刀治疗原发性三又神经痛的疗效.方法 2003年1月至2008年3月,我院应用伽玛刀治疗原发性三又神经痛120例;治疗靶点为三叉神经根,用4 mm准直器,靶点中心计量为80～90 Gy.疗效评估采用患者自我报告疼痛的控制程度及药物用量的变化.结果 所有患者进行了随访,平均随访期(20.0±4.5)个月.本组病例中治愈69例(57.5%);显效34例(28.3%)、有效12例(10.0%)、无效5例(4.2%);总有效率为95.8%.5例患者疼痛复发后行其他治疗.83例患者(69.2%)曾出现一过性、局限性的面部麻木.14例患者(11.7%)在疼痛缓解后留下持续性的面部麻木;部分患者还伴有味觉减退、口嚼无力等主诉.结论 伽玛刀治疗原发性三又神经痛能够显著缓解疼痛、提高生活质量,不良反应发生率较低:是一种较为理想的治疗方法.     

原发性三叉神经痛伽玛刀治疗结果的临床分析

目的 :分析伽玛刀治疗原发性三叉神经痛的效果。方法 :回顾分析 77例原发性三叉神经痛患者经伽玛刀治疗的结果。采用多因素Logistic回归分析确定照射部位、准直器数目和放射剂量对疼痛缓解效果和并发症的影响。结果 :随访 3～ 47个月 ,平均 2 5 6个月。 77例病人中 ,6 6例有效 ,总有效率为 85 7%。与治疗有关的并发症 13例 ,占 16 9%。多因素Logistic回归分析 ,照射部位、放射剂量对疼痛的缓解和并发症的发生有显著影响。结论 :伽玛刀是治疗原发性三叉神经痛安全有效的方法 ,合适的照射部位和放射剂量是影响治疗效果的关键     

原发性三叉神经痛伽玛刀治疗

目的：介绍伽玛刀治疗三叉神经痛１３例。方法：采用ＬｅｋｓｅｌｌＧ型立体定向仪，０．３５ＴＭＲＩ扫描定位，Ｇａｍｍａ－ＴＰＳ规划系统，国产ＯＵＲ－ＰＧＳ／Ａ型旋转式伽玛刀治疗，定位靶点为三叉神经根部或三叉神经根部及三叉神经半月节，用４ｍｍ准直器，１个～３个等中心治疗，中心剂量７０Ｇｙ～９０Ｇｙ。结果：随访１个月～１８个月，出现疼痛缓解１１例，１例先缓解后加重，现与术前相比无明显差别，１例无变化。经治     

三叉神经痛的外科治疗 : 经皮治疗或微血管减压治疗结果分析

目的比较当代治疗三叉神经痛3种外科方法的疗效。方法采用相同原则,对483例原发性三叉神经痛患者用3种不同外科方法治疗的临床效果进行分析。结果采用微血管减压(MVD)治疗155例,出院时分析获疼痛完全缓解76.1%,部分缓解19.3%,无效4.5%;平均随访52.5个月,疼痛完全缓解58.5%,部分缓解27.3%,无效14.1%。采用射频热凝(TCG)治疗113例,出院时疼痛完全缓解61.9%,部分缓解25.6%,无效12.5%;平均随访45.4个月,疼痛完全缓解2.2%,部分缓解33.7%。采用经皮球囊压迫(PMC)治疗215例,出院时疼痛完全缓解67.4%,部分缓解21.4%,无效11.2%;平均随访38.3个月,疼痛完全缓解13.6%,部分缓解29.2%,无效57.1%。结论MVD最有效,尽管PMC在治疗上也起很大作用,但应作为MVD的一种替换手段。     

伽玛刀和射波刀治疗三叉神经痛的临床观察

目的:评价伽玛刀及射波刀治疗原发性三叉神经痛病例的治疗效果、起效时间和随访观察,评价立体定向放射外科治疗原发性三叉神经痛的临床效果.方法:27例原发性三叉神经痛患者经伽玛刀治疗10例,经射波刀治疗17例.靶点选择在三叉神经根入桥脑段前3.0mm处,依据Bris-man疗效判定标准分析临床治疗效果.结果:伽玛刀组10例平均随访时间7个月,治愈和疗效显著9例,1例无效;射波刀组17例平均随访时间11个月,治愈和疗效显著15例,无效2例.结论:伽玛刀、射波刀治疗原发性三叉神经痛具有可靠疗效.射波刀与伽玛刀相比较,前者无创、无框架、非等中心、非共面、非聚焦照射为其优点,后者精度较高,定位更为准确.靶点选择和精确定位是治疗成功的关键.     

Pain control by image-guided radiosurgery for solitary spinal metastasis

Precision and accuracy of image-guided spinal radiosurgery has been previously demonstrated. This study was carried out to determine the clinical efficacy of spine radiosurgery for the treatment of solitary spinal metastases with or without cord compression. A total of 49 patients with 61 separate spinal metastases were treated with radiosurgery. All patients had pathologically proven primary cancers and had either synchronous or metachronous metastasis to the spine. The majority of the patients presented with back pain. All patients received single-dose radiosurgery to the involved spine only. The radiosurgery dose ranged from 10 to 16Gy. The primary endpoint was pain control, but outcomes in neurological status and radiological tumor control also were assessed. The median time to pain relief was 14 days and the earliest time of pain relief was within 24hours. Complete pain relief was achieved in 46%, partial relief in 18.9%, and stable symptoms in 16.2%. Relapse of pain at the treated spinal segment was 6.9%. Median duration of pain relief at the treated spine was 13.3 months. Overall pain control rate for one year was 84%. This experience demonstrates that spinal radiosurgery can achieve rapid and durable pain relief. Single-dose radiosurgery has a potential to be a viable treatment option for single spinal metastasis.     

Repeat trigeminal nerve radiosurgery for refractory cluster headache fails to provide long-term pain relief

OBJECTIVE/BACKGROUND: Medically refractory cluster headache (MRCH) is a debilitating condition that has proven resistant to many modalities. Previous reports have indicated that radiosurgery for MRCH provides little long-term pain relief, with moderate/significant morbidity. However, there have been no reports of repeated radiosurgery in this patient population. We present our findings from the first reports of repeat radiosurgery for MRCH. METHODS: Two patients with MRCH underwent repeat gamma knife radiosurgery at our institution. Each fulfilled clinical criteria for treatment, including complete resistance to pharmacotherapy, pain primarily localized to the ophthalmic division of the trigeminal nerve, and psychological stability. Both patients previously received gamma knife radiosurgery (75 Gy) for MRCH with no morbidity, but no long-term improvement of pain relief (Patient 1 = 5 months, Patient 2 = 10 months) after treatment. For repeat radiosurgery, each patient received 75 Gy to the 100% isodose line delivered to the root entry zone of the trigeminal nerve, and was evaluated postretreatment. Pain relief was defined as: excellent (free of MRCH with minimal/no medications), good (50% reduction of MRCH severity/frequency with medications), fair (25% reduction), or poor (less than 25% reduction). RESULTS: Following repeat radiosurgery, long-term pain relief was poor in both patients. Neither patient sustained any immediate morbidity following radiosurgery. Patient 2 experienced right facial numbness 4 months postretreatment, while Patient 1 experienced no morbidity. CONCLUSION: Repeat radiosurgery of the trigeminal nerve fails to provide long-term pain relief for MRCH. Given the reported failures of initial and repeat radiosurgery for MRCH, trigeminal nerve radiosurgery should not be offered for MRCH.     

ACS患者PCI手术预后影响因素的多因素分析

目的：探讨影响急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）手术预后的相关影响因素。方法连续收集2008年1月至2010年12月在重庆市巴南区人民医院心内科成功行PCI手术的ACS患者114例,随访至2015年12月,分析患者的临床资料;运用Kaplan-Meier法计算ACS患者PCI术后生存率,采用Log-rank法比较PCI手术患者不同临床特征与预后之间的关系,并采用多因素Cox回归分析筛选影响患者预后的独立危险因素。结果全部患者随访11～57个月,中位随访时间26个月;随访期间21例（18．4％）患者发生终点事件,其中一级终点事件死亡6例（5．3％）,二级终点事件复发15例（13．2％）。患者术后生存时间4～57个月,平均生存时间44．5个月,1年、2年、3年生存率（OS ）分别为85．4％、77．7％、72．6％。ACS患者PCI术预后的多因素分析显示,高血压、术后服用阿司匹林服药时间不足一年、术后服用氯吡格雷时间不足一年、术后未服用β-受体阻滞剂是影响PCI手术患者预后（发生终点事件）的独立危险因素（P＜0．05）。结论控制血压、加强PCI手术患者的长期药物治疗对ACS患者PCI术后的预后具有很重要的临床意义。     

伽玛刀对神经根与毗邻血管不同解剖关系的原发性三叉神经痛的治疗疗效分析

目的探讨原发性三叉神经痛患者三叉神经根与毗邻血管的不同解剖关系对伽玛刀治疗疗效的影响。方法回顾性分析2004年1月至2009年1月山西医科大学第二医院伽玛刀中心治疗原发性痛患者82例，依据MR定位影像显示三叉神经根与毗邻血管的不同解剖关系（无接触、可疑接触、明确接触、推移），评估对伽玛刀治疗疗效的影响。结果随访6～18个月，平均随访12．5个月，依据BNI疼痛量表评分Ⅲ级以上70例，总有效率85．4％，三叉神经根与血管无接触组有效率89．7％，可疑接触组有效率86．4％，明确接触78．9％，推移组81．8％，复发8例（9．7％）。结论三叉神经根与毗邻血管的不同解剖关系对伽玛刀治疗疗效差别无统计学意义，推移组复发率较其他组高，远期疗效有待进一步评估。     

Stereotactic radiosurgery for the treatment of trigeminal neuralgia.

Stereotactic radiosurgery is an increasingly used and the least invasive surgical option for patients with medically refractory trigeminal neuralgia (TN). The authors began use of this technique at our center in 1992 and have evaluated outcomes serially. Independently acquired data from 220 patients with idiopathic TN that had Gamma Knife radiosurgery was reviewed. The median radiosurgery dose was 80 Gy with a range of 60 to 90 Gy. Most patients had features of typical TN, although 16 (7.3%) described additional atypical features. One hundred thirty-five patients (61.4%) had prior surgery. Patients were followed to a maximum of 6.5 years (median, 2 years). Complete or partial pain relief was achieved in 85.6% of patients at 1 year. Complete pain relief was achieved in 64.9 % of patients at 6 months, 70.3% at 1 year, and 75.4% patients at 33 months. Patients with an atypical pain component had a lower rate of achieving pain relief ( p = 0.025). Due to recurrences, 55.8% of patients had complete or partial pain relief at 5 years. The absence of preoperative sensory disturbance or prior surgery correlated with an increased proportion of patients in complete or partial pain relief over time. Ten percent of patients developed new or increased subjective facial paresthesia or facial numbness. Radiosurgery for idiopathic TN was safe and effective, and provided benefit to a patient population with a high frequency of prior surgical intervention. It is an important addition to the surgical armamentarium for TN.     

Spinal cord stimulation in sympathetically maintained complex regional pain syndrome type I with severe disability. A prospective clinical study.

BACKGROUND AND PURPOSE: In this prospective trial we assessed the long-term effect of spinal cord stimulation (SCS) on the improvement of functional status in complex regional pain syndrome type I (CRPS I). METHODS: A prerequisite for eligibility to SCS treatment was the responsiveness of patients to sympathetic nerve block. In 29 patients with chronic sympathetically maintained CRPS I, the efficacy of SCS on deep pain, allodynia and functional disability was determined. Pain intensity was estimated during SCS free intervals of 45 min (inactivation test) every 3 months and compared with that under SCS treatment. RESULTS: On SCS treatment, both deep pain and allodynia could be permanently reduced from 10 to 0-2 on a 10 cm visual analogue scale (VAS) (p<0.01). During the inactivation tests, reoccurrence of pain up to 8 VAS (quartiles 6-8) was measured. Considerable impairments in daily living activities, objectified by the pain disability index, were also restored (p<0.01). After a follow-up period of 35.6+/-21 months, 12 of 16 patients with affected upper limb showed significant increase of the fist grip strength from 0 to 0.35 (quartiles 0.1-0.5) kg compared with 0.9 (quartiles 0.7-1.1) kg on the unaffected side (p<0.01). Eight of ten patients with lower limb disability resumed walking without crutches. Previous pain medication could be significantly reduced (p<0.01). CONCLUSIONS: As a result of permanent pain relief under long-term SCS combined with physiotherapy, the functional status and the quality of life could be significantly improved in sympathetically maintained CRPS I.     

内镜逆行阑尾炎治疗术诊治急性阑尾炎的初步尝试

目的:探讨内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy, ERAT)诊治急性阑尾炎的临床意义。方法:回顾性分析2018年1月至2019年9月复旦大学附属金山医院收治的30例行ERAT治疗的急性单纯性、化脓性、穿孔性阑尾炎和阑尾周围脓肿患者的临床资料。术后通过门诊或电话进行随访,分析ERAT治疗成功率、治疗后情况以及随访情况。结果:在30例急性阑尾炎患者中,ERAT成功治疗29例,成功率为96.7%(29/30)。此29例患者腹痛症状均即刻缓解。随访过程中,1例患者复发,复发率为3.4%(1/29)。结论:ERAT可有效、安全地治疗急性阑尾炎。     

立体定向放射治疗脑垂体瘤344例远期疗效观察

目的评价立体定向放射治疗脑垂体瘤在控制肿瘤生长和改变内分泌方面的长期疗效。方法1998年1月至2004年12月,应用伽玛刀治疗垂体腺瘤398例;344例获得随访,随访期18~72个月,平均46个月;针对不同组织类型肿瘤采用相应治疗剂量,应用45%~55%等剂量曲线覆盖肿瘤至少95%以上;无功能腺瘤边缘治疗剂量10~18 Gy(平均14.6 Gy),中心剂量20~36 Gy(平均28.8 Gy);功能性腺瘤边缘治疗剂量12~35 Gy(平均22.7 Gy),中心剂量24~70 Gy(平均52.9 Gy)。结果肿瘤控制生长率达91.6%,症状改善率达85.2%,激素水平下降或恢复正常达86.0%,无死亡,无严重并发症。结论立体定向放射治疗脑垂体瘤无论是对治疗首选还是对术后残存的肿瘤,其控制生长和改善内分泌的作用均是安全和有效的,治疗后影像学改变和内分泌变化与治疗剂量密切相关。