Johnson D L
Division of Neurosurgery, Children's Hospital, Penn State University School of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania.
J Neurosurg. 1993 May;78(5):813-6. doi: 10.3171/jns.1993.78.5.0813.
Idiopathic hiccups are usually managed with pharyngeal stimulation or a plethora of pharmacological agents. Hiccups that persist and prove intractable to these medical measures are treated by crush or ablation of the phrenic nerve, which denervates the major respiratory muscle. This is the first reported case of nondestructive microvascular decompression of the vagus nerve for the treatment of intractable idiopathic hiccups. The success of microvascular decompression has been documented with other conditions, such as trigeminal neuralgia and hemifacial spasm, that are characterized by hyperactive dysfunctional neurovascular contact. The vagus nerve was separated from the posterior inferior cerebellar artery by inserting a Teflon pledget between the nerve and vessel which eliminated the neurovascular contact. One year after the initial surgery, the hiccups recurred. The Teflon pledget had fallen out of place and the nerve was once again in contact with the artery. Once the contact was eliminated by wrapping the artery with a tuft of Teflon, the hiccups stopped. The patient has remained free of hiccups for 3 years. It is concluded that patients with intractable idiopathic hiccups who fail medical therapy should be considered for microvascular decompression of the vagus nerve.
特发性呃逆通常采用咽部刺激或大量药物进行治疗。对于持续存在且对这些治疗措施无效的呃逆，可通过压迫或切断膈神经来治疗，该神经支配主要呼吸肌。这是首例报道的采用迷走神经微血管减压术治疗顽固性特发性呃逆的病例。微血管减压术在其他疾病（如三叉神经痛和半面痉挛）中的成功已有文献记载，这些疾病的特征是神经血管接触功能亢进且功能失调。通过在神经与血管之间插入一块特氟龙棉片，将迷走神经与小脑后下动脉分离，从而消除了神经血管接触。初次手术后一年，呃逆复发。特氟龙棉片移位，神经再次与动脉接触。用一束特氟龙包裹动脉消除接触后，呃逆停止。该患者3年来一直未再出现呃逆。得出的结论是，药物治疗无效的顽固性特发性呃逆患者应考虑接受迷走神经微血管减压术。
