多靶点毁损治疗帕金森病疗效分析  

A efficacy analysis of multi-target damage on Parkinson disease

作　　者：顾冲[1] 陈国志[2] 谷凌云[1] 阮秋 刘坤[1] 

机构地区：[1]江苏省淮安市第三人民医院神经外科,淮安223001 [2]南京医科大学附属脑科医院神经外科

出　　处：《立体定向和功能性神经外科杂志》2011年第3期177-179,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的 ;探讨立体定向多靶点毁损治疗帕金森病（PD）的方法和影响疗效的因素。方法应用南京麦迪柯科技公司98-3型脑立体定向计算机辅助规划手术系统,螺旋CT薄层扫描解剖定位,对37例PD患者进行苍白球和（或）丘脑多靶点毁损手术,分析术后患者的靶点影像学改变和影响临床疗效的因素。结果随访3~5年,按PD联合评分标准（UPDRS）进行评分,显效24例（64.86%）,改善9例（24.32%）,无效4例（10.81%）。3年后复发再手术3例（8.1%）,3例双侧手术,近期效果满意。并发症：术后3天内对侧肢体先肌痉挛后轻度偏瘫者4例（11.0%）,远期出现肢体麻木、语音低、智能减退者4例（10.81%）。CT/MRI复查靶点毁损灶消失3例（8.10%）,靶点毁损灶稳定34例（91.89%）,无其它并发症及死亡。结论单靶点毁损且毁损灶小复发率高,多靶点毁损远期并发症高,靶点毁损术治疗PD近期疗效好,远期差。Objective To explore the methods and factors of impacting efficancy of treating PD by stero-orientation multi-target damage.Methods 37 patients with PD were damaged on globus pallidus or thalamencephalon by multi-target damage operation,and operation positions were orientated using spiral CT from type 98-3 brain stero-oriented operating system of technology Co,ltd.Nanjing Mai Dike CAP.Target imaging changes post operation and impact factors of clinical efficancy were analysed.Results 24 cases（64.86%） were significantly improved,9 cases were improved,and 4 cases no respond according to unified Parkinson Disease rating scale after 3-5 years follow-up.3 cases were reoperated due to recurrent after 3 years recent efficacy in 3 cases was better by blind operation.Complications： 4 cases with slight paralysis of appsite limbs（11.0%） after 3 days operation,4 cases of limbs appeared to be benumbed,lower sound of speaking and decreased intelligence（10.81%） after a long time target damaged area in 3 cases disappeared after CT or MRI check（8.10%）,34 cases of target damaged area were no changed（91.89%）,no other complications or death were occured.Conclusion Damaged area was smaller when using single target damage method,but recurrence was higher,complication with multi-target damged method was higher for a long time,but the efficacy of target damaged operation on PD was better in recent years,and poor for a long time.

关 键 词：帕金森病 立体定向技术 苍白球 丘脑 核团射频毁损术 

分 类 号：R742.5[医药卫生—神经病学与精神病学]