刺激术和毁损术在双侧立体定向手术治疗帕金森病中的比较  

The comparison of stimulation with ablation procedure in bilateral surgical treatment of Parkinson's disease

作　　者：胡小吾[1] 周晓平[1] 王来兴[1] 姜秀峰[1] 曹依群[1] 徐波涛[1] 金爱国[2] 曾浩[2] 

机构地区：[1]第二军医大学附属长海医院神经外科,上海200433 [2]第二军医大学附属长海医院放射科,上海200433

出　　处：《中华神经外科杂志》2004年第4期280-282,共3页Chinese Journal of Neurosurgery

摘　　要：目的比较脑深部刺激术和毁损术在双侧立体定向手术治疗帕金森病中的优缺点。方法69例帕金森病病人进行了双侧手术治疗,其中同期双侧丘脑底核(STN)脑深部刺激术(DBS)11例,同期一侧苍白球腹后部毁损术(PVP),另一侧STNDBS3例,分期一侧PVP或腹中间核(Vim)毁损术、另一侧STN或VimDBS9例;分期双侧PVP或Vim毁损术41例,同期双侧PVP5例。平均随访9.3个月。结果UPDRS评分显示刺激术和毁损术均能显著改善对侧肢体震颤、僵硬和运动迟缓症状,双侧刺激术还能改善步态和姿势症状,但双侧毁损术可加重语言、吞咽及流涎等症状,并发症较高。结论双侧DBS是具有双侧症状的帕金森病病人手术治疗的最佳术式,双侧毁损术并发症较高,应严格慎重采用。Objectives To compare deep brain stimulation(DBS) with ablation in their effects and complications in bilateral surgical treatment of Parkinson's disease. Methods Sixty-nine patients with Parkinson's disease underwent bilateral stereotactic surgical procedures. There was simultaneous bilateral subthalamic nucleus(STN) stimulation in 11 patients and simultaneous STN stimulation on one side and pallidotomy on another side in 3 patients, staged STN or ventral intermediate(Vim) stimulation on one side and pallidotomy or thalamotomy on another side in 9 patients, staged bilateral pallidotomy or thalamotomy in 41 patients, simultaneous bilateral pallidotomy in 5 patients. The mean follow-up duration was 9.3 months. Results According the subscale of Unified Parkinson's disease rating scale, both of DBS and ablation significantly improved contralateral tremor, rigidity and bradykinesia. Bilateral DBS effectively improved gait and posture, but bilateral ablation conferred a higher risk of post-operative speech, swallow, drool and other complications. Conclusion Bilateral deep brain stimulation is a most attractive alternative to other procedures.

关 键 词：帕金森病 脑深部刺激术 苍白球腹后部毁损术 丘脑腹中间核毁损术 

分 类 号：R651[医药卫生—外科学]