微电极导向脑内核团毁损术治疗帕金森病225例

Treatment of Parkinson's Disease by Microelectrode-guided Thalamotomy and/or Pallidotomy: a Report of 225 Cases

目的 探讨应用微电极导向脑内核团毁损术治疗帕金森病的适应症、毁损靶点的选择、效果、术后并发症等有关问题。方法 2 2 5例帕金森病患者 ,进行微电极导向苍白球腹后内侧部 (GPI)和 /或丘脑腹外侧核 (VIM核 )毁损术 ,分析其术后临床症状改善的情况。结果 不同症状的改善率分别为 :震颤 98 0 %,僵直 89 0 %,运动迟缓 47 8%,步态 72 8%,平衡 70 5 %,术后UP DRS评分“关”状态下降 62 6%,“开”状态下降 5 4 4%。并发症 :穿刺针道出血患者 0 48%,一过性呃逆 6 7%,暂时性的构音障碍5 5 %,一过性嗜睡 10 0 %,精神障碍 4 5 %,无严重及永久性并发症。结论 微电极导向脑内核团毁损术是治疗帕金森病安全和有效的方法 ,但应注意掌握适应症 ,正确地选择靶点并精确定位 。

Objective To explore indications, ablated targets, efficacy and complications of microelectrode-guided thalamotomy and pallidotomy for treating Parkinson's disease(PD). Methods The clinical date of 225 PD patients underwent microelectrode guided thalamotomy and/or pallidotomg were retrospectively analyzed with UPDRS scores. Results The outcome of operation was excellent.The rate of improvement for tremor, rigidity, gait, balance and bradykinesia were 98 0%, 89 0%, 72 8%, 70 5% and 47 8% respectively. Postoperative motor UPDRS scores of both 'on'/'off'states significantly decreased by 54 4% and 62 6% respectively. The frequency of post-operative complications was such as the following: bleeding caused by puncturing (0 48%),transient hiccup(6 7%), temporary dysarthria(5 5%), transient somnolence(10 0%) and mental disorder(4 5%). There were no severe and permanent complications. Conclusions The thalamotomy and/or pallidotomy guided by the microelectrode were the effective and safe method for treatment of PD, but the indications of this surgery should be well familiarize. The ablated target selection and its precise localization were of key importance for a better outcome.