Efficacy of Microvascular Decompression for Moderate to Severe Hemifacial Spasm and the Influencing Factors of Delayed Resolution
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摘要:
目的 探讨面神经显微血管减压术对中重度面肌痉挛疗效及延迟治愈的相关影响因素。 方法 选取安康市中心医院神经外科收治的2018年5月至2023年5月接受面神经显微血管减压术治疗的中重度面肌痉挛患者60例。观察患者临床疗效、术后并发症,并根据临床疗效将其分为立即治愈组与延迟治愈组,利用多因素Logistic回归分析患者延迟治愈的影响因素。 结果 60例患者中,立即治愈47例、延迟治愈13例,术后发生感染2例、听觉障碍2例、低颅压综合征1例、面瘫2例,并发症发生率为11.67%。立即治愈组与延迟治愈组病程、长期口服卡马西平、症状严重程度、注射肉毒素、血管压迫程度相比,差异有统计学意义(P < 0.05)。Logistics回归分析显示,症状严重程度、病程、血管压迫程度是延迟治愈的影响因素。 结论 病程、症状严重程度、血管压迫程度是中重度面部痉挛患者接受面神经显微血管减压术延迟治愈的影响因素,临床应密切监测以上指标并采取相应措施,使患者预后改善,生活质量提高。 Abstract:Objective To investigate the clinical efficacy of microvascular decompression for moderate-to-severe hemifacial spasm and the influencing factors of delayed resolution. Methods Sixty patients with moderate-to-severe hemifacial spasm who underwent microvascular decompression at the Neurosurgery Department of Ankang Central hospital from May 2018 to May 2023 were selected. Then the clinical efficacy and postoperative complications were were studied, and they were categorized into an immediate cure group and a delayed cure group based on clinical outcomes. Multivariate logistic regression analysis was used to determine the factors affecting delayed recovery in patients. Results Among the 60 patients, 47 were cured immediately, while 13 were cured later. There were 2 cases of infection, 2 cases of hearing impairment, 1 case of low cerebrospinal fluid pressure syndrome, and 2 cases of facial paralysis after the procedure, resulting in a complication rate of 11.67%. There were statistically significant differences (P < 0.05) in the duration of illness, long-term use of carbamazepine, severity of symptoms, injections of Botox, and degree of vascular compression between the immediate cure group and the delayed cure group. Logistic regression analysis indicated that severity of symptoms, duration of illness, and degree of vascular compression are factors influencing delayed cure. Conclusion The course of the disease, severity of symptoms, and degree of intraoperative vascular compression are influencing factors for delayed recovery in patients with moderate-to-severe hemifacial spasm undergoing microvascular decompression of the facial nerve. Clinically, it's important to closely monitor these indicators and take appropriate measures to improve the prognosis and quality of life for patients. -
表 1 延迟治愈的单因素分析[n(%)]
Table 1. Single factor analysis of delayed cure group [n(%)]
项目 立即治愈(n = 47) 延迟治愈(n = 13) t/χ2 P 性别 男 20(42.55) 6(46.15) 0.054 0.817 女 27(57.45) 7(53.85) 年龄(岁) 43.68±3.19 43.91±3.24 0.229 0.819 病程(a) 3.07±1.03 5.48±1.72 6.379 <0.001* 症状严重程度 中度 30(63.83) 3(23.08) 6.833 0.009* 重度 17(36.17) 10(76.92) 面部痉挛侧别 左 27(57.45) 7(53.85) 0.054 0.817 右 20(42.55) 6(46.15) 术后并发症 5(10.64) 2(15.38) 0.223 0.637 高血压病史 有 4(8.51) 2(15.38) 0.535 0.465 无 43(91.49) 11(84.62) 责任动脉 粗 22(46.81) 5(38.46) 0.287 0.592 细 25(53.19) 8(61.54) AMR监测 消失 23(48.94) 4(30.78) 1.626 0.444 部分消失 18(38.30) 6(46.15) 无变化 6(12.77) 3(23.08) 长期口服卡马西平 否 29(61.70) 4(30.77) 3.937 0.047* 是 18(38.30) 9(69.23) 注射肉毒素 否 28(59.57) 3(23.08) 5.432 0.020* 是 19(40.43) 10(76.92) 血管压迫程度 单一血管压迫 35(74.47) 3(23.08) 11.582 <0.001* 复合血管压迫 12(25.23) 10(76.92) *P <0.05。 表 2 延迟治愈的Logistics回归分析
Table 2. Logistics regression analysis of delayed cure group
变量 回归系数 标准误 Wald χ2 P 95%CI 病程(连续变量) 0.983 0.359 7.508 0.006 2.672 (1.323~5.398) 症状严重程度(分类变量) 2.558 1.158 4.883 0.027 12.911(1.335~124.838) 是否长期口服卡马西平(分类变量) −0.835 1.078 0.600 0.439 0.434 (0.052~3.590) 是否注射肉毒(分类变量) −0.065 1.110 0.003 0.954 0.937 (0.107~8.251) 血管压迫程度(分类变量) 2.368 1.186 3.990 0.046 10.678(1.046~109.062) 常量 −11.509 3.663 9.875 0.002 − -
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