脑深部电刺激术与毁损术治疗双侧帕金森病的疗效对照研究  

Comparison of deep brain stimulation and secondary lesion in treating Parkinson disease

作　　者：王月平[1] 王学廉[1] 李江[1] 候远征[1] 高国栋[1] 

机构地区：[1]第四军医大学唐都医院神经外科,陕西西安710038

出　　处：《医学研究生学报》2007年第2期163-166,共4页Journal of Medical Postgraduates

基　　金：国家自然科学基金资助项目(批准号:30571910)

摘　　要：目的:探讨双侧丘脑底核(STN)脑深部电刺激术(DBS)和分期双侧丘脑和(或)苍白球毁损术治疗双侧帕金森病(PD)的疗效比较。方法:2001年至2005年在该科接受双侧STN-DBS患者29例为DBS组,分期双侧丘脑或苍白球毁损术患者59例为毁损组,采用统一的PD评定量表(UPDRS),在“关”状态下对患者的日常生活活动(ADL)及运动功能进行评分(双侧DBS及第2次毁损术术前及术后1个月),计算其差值及改善率,并对并发症进行观察及评价。结果:DBS组患者ADL差值为15.93±3.98,改善率为(57.9±9.5)%,运动功能差值为29.45±5.17,改善率为(62.8±9.0)%,并发症1例。毁损组患者ADL差值为12.17±4.050,改善率为(53.8±1.2)%,运动功能差值为22.80±5.59,改善率为(59.8±1.0)%,长期及短暂并发症14例。两者术后1个月ADL及运动的UPDRS评分较术前均明显减少(P<O.01),两者改善率无显著性差异(P>0.05),并发症比较(P=0.017)有显著性差异。结论:两种治疗方法在改善患者的临床症状方面疗效均较好,但STN-DBS减少了并发症的发生,是值得推广的治疗方法。To investigate the differences of effectiveness and complication between the deep brain stimulation （DBS） in bi-lateral subthalamic nucleus （STN） and the secondary lesion of ventral intermediater nucleus or internal globus pallidus. Methods. Eigthy-eight Parkinson disease （PD） cases were treated by one of the two treatments from 2001 to 2005,29 PD cases were treated by bi-lateral STN-DBS ,59 PD cases were treated by the secondary lesion of ventral intermediater nucleus or internal globus pallidus. Based on the Unified Parkinson Disease Rating Scale （UPDRS）, we evaluated the PD activities of daily living （ADL） and movement both in the conditions of preoperative ＂off＂ and the conditions of one month after treatment,and then compared the differences and the improvement rate. Results： After DBS therapy, the difference of UPDRS score for ADL was 15.93 ± 3.98, and its improvement rate was （ 57.9 ± 9.5 ） % ;the difference for movement function was 29.45 ±5. 175, and its improvement rate was （62.8 ±9.0）%, while one complication took place. After secondary lesion therapy, the difference for ADL was 12.17 ± 4.05, and its improvement rate was （53.8±1.2） % ; the difference for movement function was 22.80 ± 5.59, and its improvement rate was （59.8 ±1.0）%, while fourteen temporary or long-term complications took place. There was a sharp decrease of UPDRS score for ADL and movement function（P 〈0.01 ） , while there was no difference about its improvement rate（P 〉0.05） one month after treatment. However, the difference about complications was significant（P =0.017）. Conclution：Both the two methods are effective, however, the STN-DBS therapy has fewer complications is worth of recommendation.

关 键 词：帕金森病 丘脑底核 脑深部电刺激术 苍白球毁损术 丘脑毁损术 

分 类 号：R742.5[医药卫生—神经病学与精神病学]