运动障碍病1135例手术治疗报告  

Surgical treatment for movement disorders:a review of 1135 cases

作　　者：李勇杰[1] 

机构地区：[1]北京功能神经外科研究所,100053

出　　处：《中华神经外科杂志》2001年第6期350-353,共4页Chinese Journal of Neurosurgery

基　　金：国家科委基金 (编号 96 92 0 0 6 0 5 17);北京市科委基金 (编号 95 330 40 0 1)资助

摘　　要：目的　探讨手术治疗运动障碍病 (MDs)的疗效、适应证、靶点选择和风险。方法　96 7名 8个病种的MDs患者接受了 1135例次的微电极导向立体定向神经外科手术。靶点选择苍白球腹后部 (PVP)、丘脑腹外侧核和丘脑底核 (STN)。通过毁损或脑深部电刺激 (DBS)靶点达到症状学治疗的目的。采用国际通用的疗效评估方法 ,对特定样本组之间进行比较。结果　帕金森病 (PD)是MDs手术治疗中主要的病种 (88 3% ) ,PVP是目前主要的治疗靶点 (6 4 8% ) ,手术明显改善了患者的生存质量。初步结果显示STN和DBS对PD的改善程度高于PVP。手术风险为 1 8%。结论　手术对MDs有肯定和持久的疗效。Objective To evaluate the outcome, indications, target selections and risks in surgical treatment of movement disorders(MDs).Methods During the past 3 years, 967 patients of MDs had received 1135 microelectrode guided operations. Treatment targets were posteroventral pallidum(PVP), ventrolateral thalamus and subthalamic nucleus(STN). Mostly lesioning and some deep brain stimulation(DBS) were employed. Evaluations such as Unified Parkinsons Disease Rating Scale(UPDRS) were made and after sargery to quantitatively compare the improvement rates between different procedure groups. Results Surgery for Parkinsons disease(PD) was the majority (88 3%) in our work, and pallidotomy was the most often employed procedure(64 8%). Stereotactic surgery is effective to treat PD(n=854), essential tremor (n=53), hemi dystonia(n=9), torsion dystonian(n=31), spasmodic torticollis(n=9), chorea(n=11) and tics(n=4). Preliminary results from 127 cases showed that subthalamic nucleus lesioning was as good as DBS implantation and better than pallidotomy in treatment of PD. Permanent complications happened in 1 8% of total patients. Conclusions Surgical treatment for MDs is safe effective and lasting. STN lesioning is a potential treatment procedure for PD, and MDs as well.

关 键 词：运动障碍病 立体定向神经外科手术 基底节区病变 靶点选择 

分 类 号：R651.1[医药卫生—外科学]