经皮穿刺微创手术治疗三叉神经多支痛术后复发的危险因素：一项回顾性队列研究

Risk factors for recurrence after percutaneous puncture minimally invasive surgery for multi-branch trigeminal pain: A retrospective cohort study

摘要:

目的 探究影响经皮微创手术治疗三叉神经多支疼痛术后复发的相关危险因素。方法 回顾性纳入2016年4月至2022年6月就诊于嘉兴大学附属医院疼痛科行经皮微创手术治疗的三叉多支神经痛患者252例,其中射频热凝组为123例,球囊压迫组为129例。术后由专人对两组患者进行定期随访,并记录两组术前(T0)、术后即刻(T1)、 3个月(T2)、6个月(T3)、12个月(T4)和15个月(T5)时的疼痛数字评分(Numerical rating scale,NRS),无复发生存率、巴罗氏面部麻木评分(Barrow Neurological Institute,BNI)。采用Kaplan-Meier法绘制复发生存曲线,计算有效率和累积复发率；采用单因素及多因素Cox回归分析确定与术后复发相关的危险因素；绘制列线图,构建复发预测模型,并验证三叉神经多支疼痛微创术后复发因素对临床实践的指导作用。结果 多变量Cox回归分析中,三个变量(侧别、手术方式、病程)为术后复发的独立危险因素。基于这些危险因素构建列线图,以预测TN术后患者的1年、2年、3年的生存期。然后利用校准曲线,和受试者工作曲线下面积(AUC)来评价预测模型的准确性和判别力。时间ROC曲线能够反映不同时间点下,某个指标对结局的预测效果。结果显示：该风险模型在预测生存风险方面具有良好的敏感性和特异性。校准曲线表明,预测与实际观察之间有良好的一致性。决策曲线显示：该模型具有较好的临床适用性。结论 多变量Cox分析显示,病程、手术方式和侧别为术后复发的独立危险因素。时间ROC曲线结果显示,该模型在术后1年、2年、3年均具有较好的预测效果。

Abstract:

Objective: To explore the related risk factors influencing the recurrence after percutaneous minimally invasive surgery for multi-branch pain of the trigeminal nerve. Methods: A total of 252 patients with trigeminal multi-branch neuralgia who underwent percutaneous minimally invasive surgery in the Pain Department of the Affiliated Hospital of Jiaxing University from April 2016 to June 2022 were retrospectively included. Among them, 123 cases were in the radiofrequency thermocoagulation group and 129 cases were in the balloon compression group. After the operation, a dedicated person conducted regular follow-up for the two groups of patients, and recorded the Numerical rating scale (NRS) of pain in the two groups before the operation (T0), immediately after the operation (T1), at 3 months (T2), at 6 months (T3), at 12 months (T4), and at 15 months (T5). Recurrence-free survival rate, Barrow Neurological Institute (BNI) score. The recurrence survival curve was plotted using the Kaplan-Meier method, and the effective rate and cumulative recurrence rate were calculated. Univariate and multivariate Cox regression analyses were used to determine the risk factors related to postoperative recurrence; Draw a nomogram, construct a recurrence prediction model, and verify the guiding role of recurrence factors after minimally invasive surgery for multi-branch trigeminal nerve pain in clinical practice. Results: In the multivariate Cox regression analysis, three variables (side, surgical method, and disease duration) were independent risk factors for postoperative recurrence. Based on these risk factors, a nomogram was constructed to predict the 1-year, 2-year and 3-year survival periods of patients after TN surgery. Then, the calibration curve and the area under the receiver operating curve (AUC) are used to evaluate the accuracy and discriminative power of the prediction model. The time ROC curve can reflect the predictive effect of a certain indicator on the outcome at different time points. The results show that this risk model has good sensitivity and specificity in predicting survival risks. The calibration curve indicates that there is a good consistency between the prediction and the actual observation. The decision curve shows that this model has good clinical applicability. Conclusion: Multivariate Cox analysis showed that disease duration, surgical method and side were independent risk factors for postoperative recurrence. The results of the time ROC curve showed that this model had a good predictive effect at 1 year, 2 years and 3 years after the operation