改良颈动脉外膜交感神经切除术治疗混合型脑瘫  

Modified cervical sympathectomy for treatment of cerebral palsy of mixed type

作　　者：徐晓利[1] 于炎冰[1] 许骏[1] 李放[1] 刘江[1] 张黎[1] 

机构地区：[1]卫生部北京中日友好医院神经外科,100029

出　　处：《中华神经外科杂志》2007年第12期891-893,共3页Chinese Journal of Neurosurgery

基　　金：北京市首发基金重点课题(2005-1053)

摘　　要：目的探讨改良颈动脉外膜交感神经切除术治疗难治性混合型脑瘫的疗效。方法回顾分析显微手术治疗的270例难治性混合型脑瘫病例,其中男性198例,女性72例,年龄2-33岁,平均12.3岁。全部采用双侧颈动脉外膜交感神经切除及迷走冲经孤立术。结果全部病人随访10-41个月,平均18.2个月。术后1周内及随访期间总显效率分别为60%(162/270)、95.6%(258/270)。术中发生颈动脉破裂2例,均临时阻断动脉后缝合修补成功,术后经过顺利。术后发生痉挛加重21例、癫痫发作5例、肠绞痛4例、声嘶2例、一侧眼睑下垂1例,均为暂时性。随访期间术后已好转症状不同程度复发者占7%(18/258)。结论改良颈动脉外膜交感神经切除术是治疗难治性混合型脑瘫安全有效的显微外科手术方法;同时行迷走神经孤立术对提高疗效有重要意义。长期随访观察有助于判断手术疗效。Objective To study the effectiveness of modified cervical sympathectomy for treatment of cerebral palsy of mixed type. Methods 270 cases of cerebral palsy of mixed type （ male 198, female 72, aged from 2 to 33 years, 12.3 in average ） were treated by bilateral microsurgical cervical sympatbectomy and trapping of cervical vagus nerves from October, 2003 to June, 2006. Results All the patients were followed-up from 10 months to 41 months （ 18.2 months in average ）. The total effective rates 60% （ 162/ 270） ,95.6% （258/270） within 1 weeks after operation and follow-up duration were 60% （ 162/270 ） , 95. 6% （258/270）respectively. Intra-operative complication： two ruptured carotid arteries were repaired by microsurgical method. Postoperative transient complications： 21 cases of aggravation of spasm, 5 cases of epilepsy, 4 cases of intestinal colicky pain, 2 cases of hoarseness, and 1 case of unilateral ptosis. The recurrence of symptoms were found in 7% （ 18/258 ） cases by follow-up studying. Conclusion Modified bilateral microsurgical cervical sympathectomy is an effective and safe microsurgical method for treatment of cerebral palsy of mixed type. The performance of trapping of cervical vagus nerves at the same time may be beneficial to the effectiveness of sympathectomy. The observation of effectiveness rely on a long term follow-up.

关 键 词：脑性瘫痪 显微外科手术 交感神经切除术 颈 

分 类 号：R651.1[医药卫生—外科学]