苍白球切开术治疗抽动秽语综合征的初步探讨  

A study on outcome and mechanism of surgical treatment for Tourette′s syndrome

作　　者：张晓华[1] 李勇杰[1] 庄平[1] 

机构地区：[1]首都医科大学宣武医院北京功能神经外科研究所,100053

出　　处：《中华外科杂志》2005年第9期608-611,共4页Chinese Journal of Surgery

基　　金：北京市科技项目基金资助项目(953304001)

摘　　要：目的探讨苍白球切开术(PVP)治疗抽动秽语综合征(TS)的疗效、安全性及电生理基础。方法应用微电极技术对22例TS患者实施单侧PVP术,采用耶鲁综合抽动严重程度评分量表(YGTSS)进行手术疗效评估;分析6例患者内苍白球(GPi)的细胞外放电信号特点。结果(1)术后YGTSS评分较术前明显降低(P<0.01),12个月随访疗效稳定。5例患者出现嗜睡等一过性并发症,无严重并发症。(2)GPi细胞放电频率为20～156Hz,有多种放电模式;对侧肢体肌电图显示GPi神经元放电与肢体抽动运动有同步性。结论PVP是治疗TS安全有效的措施,GPi神经元有多种放电模式并存在抽动同步化神经元,可能是抽动症状产生的电生理基础;损毁GPi异常活动神经元,可能是手术治疗的病理生理基础。Objective To evaluate the efficacy and safety of unilateral pallidotomy in treating Tourette syndrome (TS). The therapeutic electrophysiological mechanism of pallidotomy was analyzed according to the properties of GPi cells in TS. Methods Twenty-two patients underwent microelectrode-guided unilateral pallidotomy. All patients referred to surgery were previously failed with multiple non-surgical methods (psychopharmacological and behavioural therapy). Pre-and postoperative tic severities were rated by the Yale global tic severity scale (YGTSS). With the microelectrode recording technique, the properties of GPi cells in 6 patients were recorded and analyzed. Results (1)Postoperative scores of motor tics, phonic tics, overall impairment rating and global severity in YGTSS were significantly decreased (P<0.01). The amelioration of phonic tics was less than motor tics. The follow-up data at 12 months revealed a stable efficacy. Five cases experienced transient complications included drowsiness, intracranial pneumatocele, incontinence, diplopia and slightly facial palsy after pallidotomy, there were no permanent complications such as death, intracranial, hematoma hemiplegia and visual field defect. (2)The discharge rates of GPi neurons ranged from 20 to 156 Hz, the discharge patterns include regular, irregularly bursting and clustering mode. The synchronizations of neuronal discharge in GPi with the activities of contralateral limbs were observed also by electromyogram recorded at the same term.Conclusions (1)Pallidotomy is proven to be a safe and effective method to treat TS, it provides a significant immediate and short term reduction of tic severity in intractable Tourette′ syndrome. The long term effect of pallidotomy is confirmed also. Pallidotomy is applied to those patients with high tics scores, severe self-injured behaviors or fail to medicine treatment. (2)The low discharge rate, abnormal firing pattern and synchronized neuron are the properties of GPi neurons in TS, and maybe the pathophysiological basemen

关 键 词：抽动秽语综合征 苍白球切开术 初步探讨 电生理基础 手术疗效评估 病理生理基础 放电模式 微电极技术 YGTSS 严重并发症 神经元放电 GPi 患者实施 方法应用 评分量表 严重程度 信号特点 内苍白球 放电频率 抽动症状 手术治疗 

分 类 号：R651.1[医药卫生—外科学]