神经核团毁损术与电刺激术治疗帕金森病疗效观察

Clinical effect of nucleus lesion and deep brain stimulation on Parkinson's disease

目的观察深部神经核团电刺激术(deep brain stimulation,DBS)、神经核团毁损术治疗帕金森病的临床疗效。方法依据治疗方法,将49例帕金森病患者分为2组,27例行丘脑底核DBS术治疗者为DBS组,22例接受神经核团毁损术治疗者为毁损组,2组分别于术前,术后1、6个月及术后1、2、3a不同服药状态下进行帕金森病量表运动功能评分、日常生活评分,并比较2组左旋多巴用量及不良反应发生率。结果 2组术后1、6个月及1a帕金森病量表运动功能和日常生活评分均较术前明显降低(P<0.05);术后2、3a时DBS组帕金森病量表运动功能和日常生活评分较术前与毁损术组明显降低(P<0.05);DBS组术后6个月及1、2、3a左旋多巴服药剂量明显低于术前及毁损术组(P<0.05);DBS组术后1a不良反应发生率低于毁损组(P<0.05)。结论神经核团毁损术和DBS均为治疗帕金森病的有效方法,DBS安全性、可控性和长效性优于神经核团毁损术。

Objective To investigate the clinical effect of nucleus lesion and deep brain stimulation （DBS） on Parkinson＇s disease （PD）. Methods Unified Parkinson＇s disease rating scale （UPDRS） scores were evaluated in 27 patients receiving deep brain stimulation of subthalamie nucleus （STN-DBS） and 22 patients receiving nucleus lesion under different dose before operation, and 1 month, 6 months, 1 year, 2 years and 3 years after operation to compare the UPDRS scores, daily life scores and doses of levodopa at different time points, and incidences of adverse reaction between two groups. Results UPDRS scores and Webster scales were significantly lower 1 month, 6 months and 1 year after operation than those before operation in both two groups （P〈0. 05）, and were lower 2 years and 3 years after operation than those before operation in STN-NBS group and at the same time points in nucleus lesion group （P〈0.05）. The doses of levodopa were lower 6 months, 1 year, 2 years and 3 years after operation than those before operation in STN-NBS group and at the same time points in nucleus lesion group （P〈0.05）. The incidence of adverse reaction was lower one year after operation in STN-DBS group than that in nucleus lesion group. Conclusion Both nucleus lesion and DBS are effective on PD. STN-DBS is superior to nucleus lesion in safety, controllability and efficacy.