帕金森病立体定向手术颅内出血并发症的原因分析

Hemorrhagic complications after sterotactic surgery for Parkinson's d isease: An etiologic analysis

目的 探讨帕金森病立体定向手术颅内出血并发症的原因及对策。 方法 1999年 4月～ 2 0 0 1年 12月我们对药物治疗效果不理想的 3 50例帕金森病行立体定向毁损手术 ,术后 6例出现颅内出血 ,其中毁损灶出血 3例 ,穿刺道出血 3例。 结果 手术治疗 4例 ,保守治疗 2例。术后意识恢复但遗留偏瘫 4例 ;非手术治疗 2例 ,恢复良好 ,未遗留明显功能障碍。全组无死亡病例。 结论 颅内出血并发症与微电极反复穿刺、毁损温度过高、手术操作精细度、患者全身情况等因素有关。采用磁共振结合微电极导向提高靶点定位精确度 ,减少微电极记录针道数 ,降低毁损温度 ,重视手术操作 ,注意患者全身情况 ,加强围手术期处理等措施 。

ObjectiveTo discuss the causes and the managem ent of hemorrhagic c omplications after sterotactic surgery for Parkinson's disease (PD).Me thodsA total of 350 PD patients unresponsive to drug therapy from April 1999 to Decemb er 2001 underwent sterotactic surgery. Intracranial hemorrhage occurred in 6 cas es, consisting of 3 cases of lesion hemorrhage and 3 cases of puncture path hemo rrhage.ResultsOf the 6 cases, 4 were treated by surgical ope rations, with re covery of consciousness but hemiplegia left, and 2 were treated conservatively w ithout dysfunction left. No fatal cases were seen in the study.Conclus ionsHe morrhagic complications are often in association with repeated puncture, excessi ve heat, operative skills, patient's general condition and so on. Accurate targe t location by MRI combined with microelectrode guidance, reduce of microelectrod e recording times, lowering of the lesion temperature, and sufficient perioperat ive care contribute to the prevention of intracranial hemorrhagic complications.