帕金森病脑深部电刺激术安全性长期随访研究  

Long-term follow-up study on the safety of deep brain stimulation for treating Parkinson's disease

作　　者：吴曦[1] 陈剑春[1] 王万璐[1] 郝斌[1] 陈鑫[1] 胡小吾[1] 

机构地区：[1]第二军医大学长海医院神经外科,上海200433

出　　处：《中国现代神经疾病杂志》2015年第10期790-794,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家自然科学基金资助项目(项目编号:81171296)~~

摘　　要：目的探讨脑深部电刺激术治疗帕金森病的长期安全性，以规范操作步骤。方法采用脑深部电刺激术治疗362例帕金森病患者，共植入613根电极，记录围手术期和最后一次随访时手术相关和硬件相关并发症。结果围手术期并发症中术后嗜睡和谵妄21例（5．80％），颅内出血4例（1．10％，2例为无症状性皮质少量出血、2例为基底节穿刺针道周围少量出血），全面性强直．阵挛发作2例（0．55％），尿路感染4例（1．10％），呼吸系统感染7例（1．93％），胸部脉冲发生器囊袋内血肿11例（3．04％），脉冲发生器囊袋内血清肿3例（0．83％），均经治疗后痊愈出院。术后随访12～146个月，中位值34个月，硬件相关并发症中切口感染和（或）皮肤破溃9例（2．49％），脉冲发生器移位致延长线断裂、脉冲发生器固定线断裂致下移至腹部、因摔倒致电极轻度移位、自觉耳后切口肿胀不适各1例（0．28％）。结论脑深部电刺激术治疗帕金森病长期安全性良好。Objective To evaluate the safety of deep brain stimulation （DBS） for treating Parkinson＇s disease （PD） under long-term follow-up and modify the surgical procedure. Methods A total of 362 PD patients underwent DBS, and almost 613 electrodes were implanted into these patients. Both surgical and hardware-related complications of DBS were retrospectively analyzed. Results Perioperative complications included postoperative confusion or delirium in 21 cases （5.80%）, intracranial hemorrhage in 4 cases （1.10%; 2 asymptomatic cortical microhemorrhage and 2 basal ganglia trajectory microhemorrhage）, generalized tonic-clonic seizures （GTCS） in 2 cases （0.55%）, urinary tract infection in 4 cases （1.10%）, pulmonary infection in 7 cases （1.93%）, implantable pulse generator （IPG） hematoma in 11 cases （3.04%）, IPG seroma in 3 cases （0.83%）. All these patients were cured. They were followed-up for 12-146 months （median 34 months）. Hardware-related complications included infection of incisional wound and/or skin erosion （9 cases, 2.49%）, extension wire fracture caused by IPG displacement （one case, 0.28%）, IPG shifting to abdomen due to fixation wire fracture （one case, 0.28%）, slightly migrated electrode due to fall （one case, 0.28%）, and discomfort about occipital incision （one case, 0.28%）. Conclusions The overall risk of both surgical and hardware-related adverse events of DBS for treating PD is acceptably low.

关 键 词：帕金森病 深部脑刺激法 随访研究 

分 类 号：R651.1[医药卫生—外科学]