中枢性疼痛的神经外科治疗

Neurosurgical therapy strategy for central pain

目的 研究中枢性疼痛的神经外科治疗策略.方法 根据疼痛性质和部位的不同,行立体定向中脑毁损术1例、双侧扣带回前部毁损术2例、中脑加双侧扣带回联合毁损术9例、运动皮层电刺激术（MCS） 11例、脊髓电刺激术（SCS）3例和脊髓后根入髓区（DREZ）切开术79例次.结果 术后患者疼痛均不同程度减轻,1个月以内镇痛疗效满意,VAS评分较术前均显著降低（P＜0.01）.随访12 -36个月,观察术后6个月以上的长期疗效,发现中脑加双侧扣带回联合毁损术好于单纯中脑或扣带回前部毁损术的效果；MCS和SCS治疗的多数患者疗效有波动；DREZ切开术的长期疗效满意,82.1％的臂丛神经撕脱后疼痛患者能够保持50％以上疼痛缓解率,88.9％的脊髓损伤后疼痛患者止痛疗效长期稳定.结论 神经外科止痛手术能够确实有效地治疗中枢性疼痛,脊髓损伤、脊神经根撕脱等脊髓水平的中枢性疼痛应该首选DREZ切开术治疗,对于脑梗死、脑出血等原因造成的中枢性疼痛,MCS是一种可供选择的治疗手段.

Objective To study the neurosurgical therapy strategy for central pain.Methods The clinical evaluation of pain was based on the visual analog scale （VAS）.The mesencephalotomy was performed in one patient,bilateral anterior cingulotomy in two,while co - operation of the mesencephalotomy and bilateral anterior cingulotomy in 9 patients.11 cases of motor cortex stimulation （MCS）,3 cases of spinal cord stimulation （SCS） and 79 cases of dorsal root entry zone -otomy （DREZotomy） were applied.Results All patients were relieved of their preoperative pain after the operation.The short- term （ 〈 1 month） follow-up results indicated a significant reduction in patients＇VAS （ P 〈0.01）.In the long -term follow-up period （ 〉 6 months）,the effect of co - operation of mesencephalotomy and bilateral anterior cingulotomy was better than that of the lesion of mesencephalon or cingulate gyrus respectively.Most patients treated by MCS and SCS needed to be adjusted of the stimulation parameters in order to achieve better pain relief.In cases of DREZotomy,82.1% patients of pain after brachial plexus avulsion got satisfactory pain relief,88.9% patients of pain after spinal cord injury experienced satisfied pain relief.There was no serious complication and surgery - related mortality.Conclusions Neurosurgical procedures are efficient for the treatment for patients with central pain.DREZotomy is the primary effective operation for relieving pain due to brachial plexus injury and spinal cord injury.MCS may be helpful for post -stroke pain.