{"id":4350,"date":"2017-06-26T00:00:00","date_gmt":"2017-06-25T16:00:00","guid":{"rendered":"\/\/www.afterroberto.com\/?guid=20bcf9de0d32aa809e4735204cac31c6"},"modified":"2018-08-21T12:15:25","modified_gmt":"2018-08-21T04:15:25","slug":"%e5%95%8f%e9%86%ab%e7%94%9f%ef%bc%9a%e5%b9%b4%e9%81%8e40%e5%8a%a0%e4%b8%89%e9%ab%98-%e5%8d%b1%e4%b8%ad%e4%b9%8b%e5%8d%b1","status":"publish","type":"post","link":"\/\/www.afterroberto.com\/%e5%95%8f%e9%86%ab%e7%94%9f%ef%bc%9a%e5%b9%b4%e9%81%8e40%e5%8a%a0%e4%b8%89%e9%ab%98-%e5%8d%b1%e4%b8%ad%e4%b9%8b%e5%8d%b1\/","title":{"rendered":"\u554f\u91ab\u751f\uff1a\u5e74\u904e40\u52a0\u4e09\u9ad8 \u5371\u4e2d\u4e4b\u5371"},"content":{"rendered":"

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\/\/www.afterroberto.com\/wp-content\/uploads\/2017\/08\/db.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】鄭：鄭志文醫生 熊：熊偉民醫生 觀：Facebook Live 觀眾<\/p>\n

觀﹕哪些人較易患上三叉神經痛？<\/p>\n

熊﹕中老年人的發病率較高。許多時候，我們因為其他原因替病人做掃描，都會見到血管十分貼近三叉神經線的情况；不過，年輕人往往沒有病徵。<\/p>\n

隨着年紀增長，到了四五十歲，或會出現不同程度的血管硬化；特別是三高人士（高血脂、高血壓、高血糖），情况較差。當血管觸碰神經線，脈搏跳動帶來的衝擊也會較強。打個比喻，拿起一個吹氣鎚子或是一個鐵鎚敲打，兩者力度顯然不同。因此，年紀較大而且有血管硬化問題，容易觸發三叉神經痛。<\/p>\n

■易當牙痛 先找牙醫檢查<\/p>\n

觀﹕如何辨別三叉神經痛和牙痛？<\/p>\n

熊﹕由於三叉神經線的覆蓋範圍包括臉部、口腔、牙肉等，因此牙痛、牙周病、蛀牙、牙瘡等問題都可以出現類似三叉神經痛的徵狀；病人容易混淆。我建議先找牙醫檢查，如果檢查發現沒有問題，或者已經處理牙齒問題，仍出現三叉神經痛的典型病徵，我會歸類為三叉神經痛。<\/p>\n

鄭：現實生活，可以同時出現三叉神經痛和牙痛。到了五十多歲，牙齒未必十分健康；而且中年也是三叉神經痛發病高峰。診斷方面，可能需要團隊（家庭醫生、專科醫生、牙醫）合作。<\/p>\n

■神經線 可以一刀切？<\/p>\n

鄭﹕我有病人患有三叉神經痛，疼痛難忍。他問，把神經線切斷，可行嗎？<\/p>\n

熊﹕某些個案，我們的確會把部分的神經線切除。例如：病人痛了二三十年，神經線已經變形。即使把血管和神經線分開，已幫助不大。我們或會考慮把部分神經線削去。部分的意思是指，假設神經線有兩毫米，就會削走一毫米。<\/p>\n

這種手術跟施行微血管減壓手術做法相似。透過術中監察，確定神經線分支的位置，再削走一部分。當然，手術之前醫生會跟病人商討，並且講解手術部署。<\/p>\n

■一個噴嚏 疼痛復發<\/p>\n

觀﹕三叉神經痛可否斷尾？是否做了手術就一勞永逸？<\/p>\n

熊﹕如果三叉神經線受到鄰近血管擠壓，微血管減壓手術是徹底治理的方法。它能根治痛楚的成功率達到百分之八十五至九十。病人做完手術，再無痛楚，可以斷尾。<\/p>\n

餘下一成五手術效果不如理想。原因包括：<\/p>\n

‧疼痛持續多年；單是把血管和神經線分隔，幫助不大<\/p>\n

‧不止一條神經線被血管壓住，可能兩條甚至三條。手術時，醫生需要小心查看，有否其他血管（包括靜脈）擠壓神經線<\/p>\n

‧手術時，醫生加入軟墊分隔神經線和血管。有時候，保護軟墊可能鬆脫。曾聽說有一位高大的男病人，術後已經康復。突然一個噴嚏，可能動作太大，令到軟墊鬆了，疼痛復發。<\/p>\n

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