Wilkinson H A, Chan A S
Division of Neurosurgery, Newton-Wellesley Hospital, Newton, Massachusetts, USA.
J Neurosurg. 2001 Jul;95(1):61-6. doi: 10.3171/jns.2001.95.1.0061.
Sensory ganglionectomy offers theoretical advantages over rhizotomy but remains controversial because reported success rates vary widely. The authors sought to add to the available data on this subject and to review technical aspects of the surgery.
This retrospective chart review included 19 patients, in whom 22 operations were performed and 35 sensory ganglia were resected between May 1995 and May 1999. The eight women and 11 men ranged in age from 27 to 75 years (median age 40 years, average age 42.3 years). All patients had undergone extensive therapy and a mean of 2.4 previous operations (median three, range zero-eight operations) for their pain, all without long-term pain relief. Duration of symptoms varied, from 1 month (for the cancer patient) to 15 years (mean 5.9, median 4 years). Preoperatively, all patients underwent diagnostic selective nerve root blocks, which temporarily relieved their targeted pain. The duration of follow up averaged 22 months (median 13, range 1.5 [to death of the cancer patient]-58 months). Before undergoing the first ganglionectomy, nearly all patients rated their targeted pain as 8 to 10 (average 9.6, median 10) on an analog (0-10) pain scale. At 6 months all patients rated their ganglionectomy-specific pain as an average of 4.5 (median 4, range 0-8), and pain reduction of 50% or more was achieved in 74%. At 1 year or more the 13 patients available for study rated their pain as an average of 4.3 (median 4.5, range 0-9). There were no severe complications, residual pain was never worse than presurgical pain, and no patient experienced significant or lasting new motor deficits.
Dorsal root ganglionectomy has a useful role in the treatment of a variety of refractory pain states, especially those involving radicular pain.
感觉神经节切除术相较于神经根切断术具有理论优势，但由于报道的成功率差异很大，该手术仍存在争议。作者试图补充关于此主题的现有数据，并回顾该手术的技术方面。
这项回顾性病历审查纳入了19例患者，在1995年5月至1999年5月期间进行了22次手术，切除了35个感觉神经节。8名女性和11名男性年龄在27至75岁之间（中位年龄40岁，平均年龄42.3岁）。所有患者均接受了广泛的治疗，因疼痛平均接受过2.4次先前手术（中位次数为3次，范围为0至8次手术），但均未获得长期疼痛缓解。症状持续时间各不相同，从1个月（癌症患者）到15年（平均5.9年，中位4年）。术前，所有患者均接受了诊断性选择性神经根阻滞，该阻滞暂时缓解了他们的目标疼痛。随访时间平均为22个月（中位时间13个月，范围为1.5个月[至癌症患者死亡]至58个月）。在进行首次神经节切除术之前，几乎所有患者在模拟（0至10）疼痛量表上对其目标疼痛的评分均为8至10分（平均9.6分，中位10分）。6个月时，所有患者对其神经节切除术特异性疼痛的平均评分为4.5分（中位4分，范围为0至8分），74%的患者疼痛减轻了50%或更多。1年或更长时间时，可供研究的13名患者对其疼痛的平均评分为4.3分（中位4.5分，范围为0至9分）。没有严重并发症，残留疼痛从未比手术前更严重，也没有患者出现明显或持久的新运动功能障碍。
背根神经节切除术在治疗各种难治性疼痛状态，尤其是涉及神经根性疼痛的状态中具有有用的作用。
