立体定向手术治疗帕金森病——附669例临床分析  

The stereotactic surgery in Parkinson' s disease: an analysis of 669 cases

作　　者：石长青[1] 李勇杰[1] 

机构地区：[1]首都医科大学宣武医院,北京市功能神经外科研究所,北京100053

出　　处：《现代神经疾病杂志》2002年第5期264-269,共6页

基　　金：国家科技部基金(编号 96-920-06-05-17);北京市科学技术委员会基金(编号953304001)

摘　　要：目的 观察立体定向手术治疗帕金森病的疗效,探讨手术靶点与适应证的选择原则。方法对669例帕金森病患者实施微电极导向立体定向毁损与脑深部电刺激术,单靶点分别选择苍白球腹后部(314例)、丘脑腹外侧核(48例)及丘脑底核(48例);多靶点则为单靶点的结合(259例)。手术后采用UPDRS评分进行疗效评估和随访。结果 与手术前UPDRS评分相比:(1)丘脑底核切开术对“关”时相疗效最佳(P<0.05);(2)丘脑腹外侧核对震颤有效,改善率达97％,丘脑底核对僵直和运动迟缓有效,改善率分别为85％和57％;(3)多靶点手术对难治性帕金森病患者有显著疗效(P<0.01);(4)手术后丘脑底核切开组左旋多巴用量减少45％(P<0.05);(5)手术后总复发率为1.79％(12/669),永久性并发症发生率为2.39％(l6/669)。结论 外科手术对帕金森病有肯定而持久的疗效,手术前明确诊断及适应证、靶点选择是手术成功的重要前提。手术后仍须继续药物治疗。丘脑底核可能是最具潜力的治疗性核团。Objective To study the therapeutic effect on surgical treatment in Parkinson's disease (PD). Methods The microelectrode guided stereotactic operation and electric deep brain stimulation were performed in 669 patients with PD. The single target was selected at postventral pallidum (n = 314), ventralat-eral nucleus of thalamus (ra = 48) and subthalamus nucleus (re = 48), multitargets were the combination of single targets (re = 259). The therapeutic effects were evaluated with unified Parkinson's disease rating scale (UP-DRS) and following up after operation. Results Compared the UPDRS results in postoperation with that of preoperation: 1) Best effects of postventral pallidotomy was resulted in off phase (P<0.05); 2) Operation of ventralateral thalamus nucleus was effective for tremor with improvement rate 97%, subthalamus nucleus operation was effective for rigidity and bradykinesia with improvement rate of 85% and 57% respectively; 3) Multitarget operation was effective for intractable PD with significant improvement (P<0.01); 4) After subtha-lamotomy, the L-Dopa dosage was reduced 45% (P<0.05); 5) The recurrence rate was 1.79% (12/669) after operation and the occurrence rate of permanent complication was 2.39% (16/669). Conclusion Surgical treatment is safe and persisting effective for PD. The accurate diagnosis, strict selection of target and indication is the key to success of operation. Postoperative continuation of drug therapy is necessary. The subthalamus nucleus may be the most potential therapeutic nuclear cluster.

关 键 词：治疗 临床分析 帕金森病 立体定位技术 微电极 苍白球 丘脑核 外科手术 

分 类 号：R651.1[医药卫生—外科学]