帕金森病微电极导向手术后并发症的探讨

Cause analysis and treatment of microelectrode-guided stereotactic surgery for Parkinson's disease.

目的 分析微电极导向立体定向手术并发症的发生原因及防治对策。方法 对应用微电极导向手术治疗的1300例帕金森病患者中的46例并发症进行了归类,原因分析,愈后观察及防治措施的探讨。结果 并发症总发生率3.54％,短暂性并发症28例（2.15％）,持久性并发症18例（1.38％）;特异性并发症34例（2.62％）;非特异性并发症12例（0.92％）。重残4例（0.31％）,死亡2例（0.15％）。结论 微电极导向技术本身安全性极高,对脑组织损伤极小。影响并发症发生的因素有:不合理地使用微电极导向技术;操作急躁、粗暴;脑脊液丢失、脑萎缩等造成的靶点偏移;未严格掌握手术适应症;患者术前的心理及身体状况等。以核团内部结构为参考点,合理使用微电极导向技术;操作仔细轻柔;封闭蛛网膜下腔减少脑脊液丢失;严格掌握手术适应症;了解患者术前的心理及身体状况并耐心解释消除其紧张恐惧感,可减少并发症的发生。

Objective To investigate the causes and prevention of complications of microelectrode-guided stereotactic surgery for Parkinson's disease.Methods Among 1 300 cases who underwent microelectrode-guided stereotactic operation, complications occurred in 46 cases. We classified these complications, analysed the reasons, observed the out comes and discussed the prevention measures.Results The complication rate was 3.54% and the complications were classified as transient(28, 2.15%), sustained(l8,1.38%), specific(34,2.62%) and non specific( 12,0.92%) . Conclusions The technique of microelectrode-guided stereotactic surgery did not damage brain tissue in itself. Factors that affected complications occurrence included the follow-ings:improperly use of microelectrode-guided technique, impetuous and rough operation, displacement of target as a result of CSF leakage and brain atrophy, inattentive selection of candidates and inadequate preparation of the psychological and physical status of patients. To reduce the complication of microelectrode-guided surgery, surgeon should use internal structure of lesion nucleus as reference points, operate meticulously and gently, minimize leakage of CSF by blocking subarachnoid space, select candidates carefully, assess the psychological and physical status of patients and provide clear explanation of the surgery before operation.