分期立体定向双侧多靶点毁损术治疗帕金森病  

Staged bilateral multi-targets pallidotomy and thalamotomy for Parkinson's disease

作　　者：郭效东[1] 高国栋[1] 李立宏[1] 李维新[1] 王学廉[1] 张华[1] 梁秦川[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710038

出　　处：《立体定向和功能性神经外科杂志》2004年第3期129-132,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的　探讨分期双侧多靶点毁损术的疗效、适应证、靶点的选择及并发症。方法　对比第一次手术35 0例与第二次手术 387例患者的UPDRS评分、评分改善率、并发症及主要症状改善率 ,进行统计学分析。结果　两次手术均有显著近期疗效 ,二次手术单项症状改善率为震颤 95 .3%、僵直 94 .6 %、运动迟缓 82 .9%、步态6 2 .4 %、平衡 6 5 .3%、异动症和痛性痉挛 96 .4 % ,总有效率 97.2 %。第二次手术总体改善率较第一次低 ,一过性特异性并发症增多 ,能于短期内恢复 ,永久性并发症发生率为 5 .4 3%。美多巴用量较术前减少。结论　分期双侧多靶点毁损术治疗帕金森病是一种有效、安全的方法 ,术前选好手术适应证、手术方式至关重要 。Objective To explore the effect of staged bilateral multi targets of pallidotomy and thalamotomy for PD and their complication,and to select indication and targets of the operation.Methods We contrasted the first operation of 350 patients with the second operation of 387 patients,containing the scores of UPDRS,the improvement rate of scores and main symptoms,surgical complications,and then analyzed the statistical figures.Results All the symptoms of PD were significantly improved after operation,the improvement rate of main symptoms of the second operation were 95.3% (tremor),94.6% (rigidity),82.9% (bradykinesia),62.4% (gait),65.3% ,(balance)96.4%,and the total efficiency was 97.2%.But the total improvement rate of the second operation was decrease than the first operation's,and transient specific complication was increase than first operation's,most complication can recovery in short time.The permanent complication rate was 5.43% on the second operation.The dose of Madopar was less than the pre operation.Conclusion It is safe and effective that staged bilateral multi targets pallidotomy and thalamotomy for PD.It is key to success of operation that indications and surgical method are strictly selected,and interval was above half a year between the twice surgeries.

关 键 词：帕金森病 苍白球腹后内侧部毁损术 丘脑腹中间核毁损术 

分 类 号：R742.5[医药卫生—神经病学与精神病学]