立体定向脑内核团毁损术与脑深部电刺激术治疗帕金森病的对比分析(附79例报道)

Comparative analysis of Parkinson's disease with the treatment of stereotactic intracerebral nucleus lesion and deep brain stimulation:report of 79 cases

目的对比立体定向脑内核团毁损术和脑深部电刺激术(DBS)治疗帕金森病的临床效果。方法选取我院2014年6月至2017年6月收治的79例帕金森病患者,根据治疗方法不同分为毁损组和DBS组,比较两组术前1周、术后1个月和术后1年的UPDRS运动功能和ADL日常生活评分,以及两组术后1周不良反应和并发症的发生率。并通过随访观察术后复发情况。结果 79例患者中,70例行脑内核团毁损术,全部为单侧毁损,其中Gpi毁损8例,Vim核毁损62例。9例患者接受DBS手术,全部为双侧STN-DBS。两组在术后1个月和术后1年的UPDRS运动功能和ADL日常生活评分与术前1周比较有显著性差异(P<0.05);同时比较毁损组和DBS组在各个时间点的评分,发现两组在各个时间点的评分比较无显著性差异(P>0.05)。毁损组术后有10例患者出现轻偏瘫,脑出血4例,感觉障碍4例,视野缺损2例,吞咽困难2例,随访发现7例不同程度复发。而DBS组除1例出现近期精神症状外,无远期并发症和复发病例发生。结论脑深部电刺激术(DBS)和脑内核团毁损术均是治疗帕金森病的有效方法,但是DBS具有非破坏性、可双侧同期手术、术后可调节以及并发症少等优点,是一种值得推广的治疗方法。

Objective To compare the clinical effect of Parkinson＇s disease with the treat- ment of stereotactic intracerebral nucleus lesion and deep brain stimulation（DES）. Methods 79 cases of Parkinson＇s disease were admitted into our hospital from June 2014 to June 2017. Accord- ing to different operative methods they were divided into lesion group and DES group. UPDRS and ADL of both groups were compared 1 week before--operation, 1 month after--operation and 1 year after--operation. The side--effect and complication rate were also observed. And the post-- operative recurrence was followed--up. Results 70 cases received stereotactic intracerebral uni lateral nucleus lesion （62 Vim and 8 Gpi） and 9 bilateral STN--DBS. There was significant differ- ence（P〈0.05）in UPDRS and ADL of both groups between 1 week before--operation , 1 month after--operation and 1 year after--operation. While there was no difference（P〈0. 05） in the scores of different times between the two groups. In the lesion group, there were 10 cases of slight hemiplegia, 4 cases of intracerebral hemorrhage, 4 cases of sensory dysfunction, 2 cases of eyesight dysfunction and 2 cases of swallow dysfunction. The follow--up showed 7 cases recurred. While in DBS group only 1 case had psychiatric symptom, and there was no other complication or recur- rence. ConcLusion Stereotactic intracerebral nucleus lesion and DBS are effective treatments of Parkinson＇s disease. But DES is of the advantages of non--destruction,bilateral synchronical sur-gery,post--operative adjustability and less complication. So it is worth of recommendation.