帕金森病的定向手术适应证

Indications of stereotactic and functional neurosurgery for Parkinson's disease

目的 确定各类帕金森病的定向手术适应证。方法 回顾分析 1478例帕金森病定向手术 ,对手术后的手术疗效和某些相关并发症进行评估 ,进而推断各类帕金森病的定向手术适应证。结果 苍白球毁损术对服用左旋多巴类药物有效的震颤患者均有效 ,服用左旋多巴类药物震颤无效的患者 ,苍白球毁损术的手术疗效效果很差 ,单侧丘脑Vim核毁损术对震颤改善极佳 ,96 9%的患者彻底消失 ,同期同侧苍白球 +丘脑Vim核毁损术的患者震颤改善率为 96 3% ,苍白球毁损术对僵直、运动迟缓的疗效也显示出与左旋多巴服药反应的规律性 ,服药效果好的手术效果较好 ,但是 ,与震颤不同的是 ,服药无效的也有一定的疗效。启动不能患者 ,其手术效果都不佳 ,流涎、吞咽困难发生率在单侧苍白球毁损术患者中较低 ,乏力发生率较高 ,分期双侧苍白球毁损术中患者年龄较大的较易发生乏力、流涎、吞咽困难。结论 我们的临床实践认为左旋多巴类药物服药反应是一个非常重要的判定指标 ,僵直、运动迟缓、药物引起的“开 关”、异动症服药有效的患者 ,苍白球毁损术的效果较好 ;震颤则有所不同 ,凡是左旋多巴不能完全控制的 ,采用苍白球 +丘脑Vim核毁损术则手术效果非常满意 ,启动不能的患者手术应该极其慎重 ,手术的帮助不大。

Objective To identify indications of stereotactic operations for Parkinson's disease. Methods We retrospectively analysis 1478 operations, then deduce the indications of different operations. Results Every patient suffering from tremor showed improvement after pallidotomy when L-dopa was effective, whereas a few patients showed improvement after pallidotomy when L-dopa didn't work. Tremor disappeared in 96.9% patients after vim-thalamotomy and 96.3% patients after pallidotomy+vim-thalamotomy. Rigidity and bradykinesia also showed great improvement after pallidotomy when L-dopa was effective. Although L-dopa didn't work, there were still some improvements on rigidity and bradykinesia. Pallidotomy showed no significant improvement on gate freezing. Complications are prone to happen in bilateral-pallidotomy and staged bilateral-pallidotomy, especially in bilateral-pallidotomy. Conclusions The response to L-dopa is crucial in judgments of operations for Parkinson's disease. Operation is not suitable to gait freezing, simultaneous bilateral-pallidotomy should be avoided for complications, staged bilateral-pallidotomy is not suitable for the old and weak.