经皮球囊压迫术中初压维持策略对术后疗效 及复发的影响

Effect of Initial Pressure Maintenance Strategy in Percutaneous Balloon Compression on Postoperative Efficacy and Recurrence

摘要: 背景：三叉神经痛(TN)因剧烈疼痛而严重危害患者健康。经皮穿刺三叉神经球囊压迫术(PBC)作为一种重要微创治疗手段，通过充盈球囊选择性损伤半月节内有髓纤维，阻断疼痛传导。与传统术式相比，其具有创伤小、恢复快等优点，且可通过调节球囊充盈参数控制疗效。然而，术中是否应主动维持囊内压力恒定及其对患者远期预后的影响，目前尚无定论。本研究旨在固定压迫时间的前提下，探讨术中维持球囊初始压力对PBC术后疗效及复发的影响，以期为优化手术操作、提高长期缓解率提供客观依据。方法：回顾性纳入2021年1月至2023年12月于我院接受PBC治疗且符合标准的106例TN患者。根据术中压力管理方式分为两组：维持初压组(n = 49)，使用连续测压计动态调控，使球囊在形成理想梨形后维持其初始压力(波动范围 ± 5%)持续压迫120 s；非维持组(n = 57)，球囊充盈至梨形后停止调控，囊内压自然衰减，同样压迫120 s。术后随访至少24个月，评估并比较两组患者的疼痛缓解程度、复发率及相关并发症。结果：两组患者在年龄、性别、病程、疼痛侧别及受累分支等基线资料上均衡可比(P > 0.05)。术中压力监测显示，两组初始充盈压力无统计学差异(P = 0.791)；但维持初压组的平均压力及压迫末期的压力均显著高于非维持组，且压力下降百分比显著更低(P < 0.001)，效应量大(r = 0.86)。术后早期(24小时、3个月)疼痛缓解率组间无显著差异(P > 0.05)。术后1年，维持初压组的疼痛缓解率(95.90%)显著高于非维持组(84.20%, P = 0.049)。术后24个月，维持初压组的复发率(8.20%)显著低于非维持组(22.80%, P = 0.041)，Kaplan-Meier生存分析显示其累积无痛生存率更优(P = 0.039)。并发症方面，术后3个月维持初压组面部麻木发生率较高(63.30% vs. 36.80%, P = 0.007)，但两组在咀嚼肌无力、口周疱疹等其他并发症发生率上无显著差异(P > 0.05)，均无严重并发症发生。结论：术中球囊内初压力维持策略(±5%)可在不增加术后并发症发生率的情况下增强镇痛效果的持久性，是一种有效、安全的新方法。

Abstract: Background: Trigeminal neuralgia (TN) severely compromises patient health due to its excruciating pain. Percutaneous balloon compression (PBC), as a key minimally invasive treatment, selectively damages myelinated fibers within the ganglion by inflating a balloon to block pain transmission. Compared to traditional procedures, it offers advantages such as reduced trauma and faster recovery, while therapeutic efficacy can be controlled by adjusting balloon inflation parameters. However, whether to actively maintain constant intraballoon pressure during the procedure and its impact on long-term patient outcomes remain inconclusive. This study aims to investigate the effects of maintaining initial balloon pressure during PBC on postoperative efficacy and recurrence rates, while keeping the compression duration constant, to provide objective evidence for optimizing surgical techniques and improving long-term relief rates. Methods: A retrospective cohort study included 106 TN patients who underwent PBC at our hospital between January 2021 and December 2023 and met the inclusion criteria. Patients were divided into two groups based on intraoperative pressure management: Initial Pressure Maintenance Group (n = 49): Continuous pressure monitoring dynamically adjusted balloon pressure to maintain the initial pressure (±5% fluctuation range) after achieving an ideal pear-shaped contour, with sustained compression for 120 seconds. Non-Maintenance Group (n = 57): Balloon pressure was adjusted only until achieving a pear-shaped contour, after which pressure was allowed to decay naturally, with compression maintained for 120 seconds. Patients underwent at least 24 months of postoperative follow-up to evaluate and compare pain relief, recurrence rates, and related complications between groups. Results: Baseline characteristics including age, gender, disease duration, pain side, and affected branches were comparable between groups (P > 0.05). Intraoperative pressure monitoring revealed no statistically significant difference in initial filling pressure between groups (P = 0.791). However, the mean pressure and end-compression pressure were significantly higher in the initial pressure maintenance group compared to the non-maintenance group, with a significantly lower percentage of pressure decline (P < 0.001) and a large effect size (r = 0.86). Early postoperative pain relief rates (at 24 hours and 3 months) showed no significant intergroup differences (P > 0.05). At 1 year postoperatively, the pain relief rate in the initial pressure maintenance group (95.90%) was significantly higher than that in the non-maintenance group (84.20%, P = 0.049). At 24 months postoperatively, the recurrence rate in the initial pressure maintenance group (8.20%) was significantly lower than that in the non-maintenance group (22.80%, P = 0.041). Kaplan-Meier survival analysis demonstrated superior cumulative pain-free survival in the initial pressure maintenance group (P = 0.039). Regarding complications, the initial pressure maintenance group exhibited a higher incidence of facial numbness at 3 months postoperatively (63.30% vs. 36.80%, P = 0.007). However, no significant differences were observed between groups for other complications such as masticatory muscle weakness or perioral herpes (P > 0.05), and no severe complications occurred in either group. Conclusion: The intraoperative balloon pressure maintenance strategy (±5%) enhances the durability of analgesia without increasing postoperative complication rates, representing an effective and safe novel approach.