颈动脉外膜交感神经切除术治疗难治性抽动障碍的疗效分析

Analysis of the therapeutic effect of modified cervical sympathectomy in the treatment of refractory tic disorders

目的探讨颈动脉外膜交感神经切除术治疗难治性抽动障碍(TD)的临床效果。方法回顾性分析中日友好医院神经外科自2018年1月至2020年7月行颈动脉外膜交感神经切除术的17例难治性TD患者的临床资料,术前及术后1年采用耶鲁综合抽动严重程度量表(YGTSS)评分对患者抽动严重程度进行评估,分析其治疗效果。结果17例患者术后的YGTSS评分中的运动性抽动评分为6.0(4.0,8.5)分,综合抽动严重程度评分为18.0(14.5,19.0)分,均较术前[16.0(13.0,17.0)分,46.0(31.0,58.5)分]明显降低,差异具有统计学意义(Z=-3.527、-3.524,均P<0.001)。所有患者术后无声嘶等并发症。结论颈动脉外膜交感神经切除术可以作为治疗难治性TD患者的一种新选择,其安全、可靠,长期随访疗效稳定。

Objective To explore the clinical effect of modified cervical sympathectomy in the treatment of refractory tic disorders(TD).Methods The therapeutic effect for patients is evaluated base on retrospective analysis of clinical data of 17 patients with refractory TD admitted to Neurosurgery Department of China-Japan Friendship Hospital from January 2018 to July 2020 and treated with cervical sympathectomy,and through the Yale global tic severity scale(YGTSS)before and one year after the surgery.Results The median of the exercise-induced tic scoring in the postoperative YGTSS scoring of 17 patients was 6.0(4.0,8.5)points,and the global tic severity was rated as 18.0(14.5,19.0)points;both of them were significantly smaller than the preoperative scores[16.0(13.0,17.0)points,46.0(31.0,58.5)points]and the differences were statistically significant(Z=-3.527,-3.524,respectively,with P<0.001).No hoarseness and other complications were found after surgery in all patients.Conclusion As a new option for the treatment of patients with refractory TD,modified cervical sympathectomy is safe and reliable,with long-term stable effects as shown in the long-term follow-up results.