目的：乙状窦后入路显微血管减压术（MVD）联合三叉神经感觉根部分切断术（PSR）已经成为原发性三叉神经痛（TN）最有效的外科治疗方式，术后患者的恢复过程存在着多样性。本研究的目的在于探讨MVD和（或）PSR治疗TN术后的延迟治愈（DR）及其影响因素，并研究DR对术后长期疗效的影响。

方法：将2009年3月至2017年12月在中日友好医院由同一术者实施MVD和（或）PSR的原发性TN患者纳入本研究，所有患者均随访1年及以上。治疗前后的疼痛程度使用巴罗神经学研究所疼痛评分进行评估。对比DR组和非DR组术前、术中及术后的差异，并分析各因素（包括：人口学及临床特点资料、术中情况及长期疗效）与DR之间的关联。

结果：共105例患者被纳入这项研究，其中DR 20例（19%），非DR 78例（74%），无效7例。随访13个月-118个月，平均5.39年（65个月）。术后DR组疼痛的持续时间为3天-365天，平均108天。统计学分析发现没有任何因素会预示着DR的发生，DR的发生并不会影响到患者的长期疗效。

结论：对于TN行MVD或（和）PSR术后即刻疼痛症状无明显缓解的患者，由于存在DR的可能而且DR并不会影响患者的长期疗效，建议观察3个月后再评价疗效，不应该立即盲目地再次进行手术治疗。

Objective:

Microvascular decompression (MVD) combined with partial sensory rhizotomy (PSR) with the retrosigmoid approach has become the most effective surgical treatment for trigeminal neuralgia (TN). There was variability in the pain relief processes in postoperative patients. The purpose of this study was to investigate delayed relief (DR) and its predictors after MVD and/or PSR for the treatment of TN and to study the long-term effects associated with DR.

Methods:

  Patients with primary TN who underwent MVD and/or PSR by the same surgeon at the China-Japan Friendship Hospital from March 2009 to December 2017 were included in the study, and all patients were followed for at least 1 year after the operation. The degree of preoperative and postoperative pain was assessed by the Barrow Neurological Institute (BNI) pain intensity scale. Preoperative, intraoperative and postoperative differences between the DR and non-DR groups were compared, and the relationship between the various factors (including demographic data and clinical characteristics; intraoperative findings; and long-term effects) and DR was analyzed.

Results:

A total of 105 patients, including 20 patients with DR (19%), 78 patients with non-DR (74%), and 7 patients without relief, were included in this study. The follow-up period ranged from 13 months to 118 months, with an average of 5.39 years (65 months). The duration of postoperative pain in the DR group was 3-365 days, with an average of 108 days. Statistical analysis found that no factor predicted the occurrence of DR, and the occurrence of postoperative DR did not affect the long-term effects of patients.

Conclusion:

  For the patients with TN who experienced no immediate pain relief after MVD and/or PSR but experienced DR, DR did not affect the long-term effects. Therefore, it is recommended to observe patients for approximately 3 months after MVD and/or PSR and then evaluate the surgical effects; reoperations should not be performed immediately.