三叉神经痛周围支撕脱术后复发的原因分析及处理

目的：分析三叉神经周围支撕脱术后复发的原因，并行相应手术治疗，提高手术治愈率。方法：对27例三叉神红痛患者行三叉神经第Ⅱ、Ⅲ支撕脱术后复发的病例，根据疼痛复发部位确定残余神经分支，并采用彻底切断及神经干高位切断的方法再行治疗，随访并评估治疗效果。结果：三叉神经第Ⅱ支术后复发痛19例，多在术后6～12个月复发，其中眶外段神经分支残留痛10例，眶内段神经干撕脱不彻底8例，转为第Ⅲ支神经痛1例。第Ⅲ支术后疼痛8例，颊神经未彻底切断4例，舌神经复发痛2例，下牙槽神经未完全切断2例。结论：三叉神经术后复发痛多因神经及分支切断不彻底，术后易有神经残余。三叉神经痛第Ⅱ支的复发率高于第Ⅲ支，因上颌神经解剖走行复杂，应注意彻底切断。针对复发原因，可采用高位及多分支神经切断术，同时可结合颌骨痛点进行骨腔清除术，以提高治疗效果。

Analysis and Treatment of Postoperative Recurrence of Trigeminal Neuralgia

Objective:To analyse the causes of postoperative recurrence of trigeminal neuralgia and to improve the therapeutic efficacy.Methods:The clinical data of 27 cases with recurrent trigeminal neuralgia were studied.According to the location of recurrent pain,different operations were used to cut the residual nerve branches with or without curettage of the bone cavities.Results:19 cases with recurrent pain in the V2 trigeminal territories were manifested from 6 to 12 months after operation,10 cases complained pain in the infraobital nerve,8 with maxillary nerve and 1 case translocated into trigeminal neuralgia(V3).Among the 8 cases with recurrence pain in the V3 trigeminal territories,4 cases with branch remainder of buccal nerve,2 cases with branch remainder of lingual nerve,2 cases with branch remainder of inferior alveolar nerve.Follow-up study for 1-9 years,all cases those received retreatment had no complaints.Conclusion:Recurrence rate of trigeminal neuralgia(V2)is higher than trigeminal neuralgia(V3)by reasons of complex anatomic structures.Multifiliation of trigeminal nerve and inadequate neuragmy were the main recurrence reasons.Surgery therapy trigeminal neuralgia in perch and multifiliation and curettage of the bone cavities may be effective for the recurrent cases.