立体定向手术治疗难治性抽动-秽语综合征  

Immediate and short term outcome after pallidotomy for intractable Tourette's syndrome

作　　者：张晓华[1] 李勇杰[1] 

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

出　　处：《立体定向和功能性神经外科杂志》2004年第2期88-90,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的　外科手术治疗难治性抽动 秽语综合征 ,至今仍处于尝试性治疗阶段。实施单侧苍白球腹后部毁损术 ,观察PVP手术对治疗难治性抽动 秽语综合征的疗效和安全性。方法　我科从 1999年 8月至 2 0 0 2年 12月期间 ,共收治 14例抽动 -秽语综合征患者 ,平均年龄 2 0 .3岁 ,平均病程 11.9年。术前经过系统的精神科药物及心理行为治疗 ,仍不能控制症状 ,均为难治性。所有患者均在MRI和微电极导向下行立体定向苍白球射频毁损术。在手术前、术后 1周、术后 6个月应用耶鲁综合抽动严重程度量表 (Yaleglobalticseverityscale ,YGTSS)进行评分。结果　手术后YGTSS的运动抽动评分、发声抽动评分以及总的严重程度均较术前明显减少 ,具有统计学意义(P <0 .0 1)。结论　苍白球切开术是治疗难治性抽动 秽语综合征安全有效的治疗方法之一 。Objective The surgical treatment of intractable Tourette's syndrome is world widely controversial.Therapeutic outcome of 14 consecutive patients is reviewed and the efficacy and safety of unilateral pallidotomy is assessed.Methods 14 patients were retrospectively studied,median age was 20.3 years (range 14～35) at the time of surgery.Median duration of illness was 11.9 years (range 7～22).All patients referred to surgery were previously failed with multiple non-surgical methods (psychopharmacological and behavioural therapy),and stereotactic microelectrode-guided pallidotomy were performed.Patients were rated for ticseverity by the Yale global tic severity scale (YGTSS) before and after operation.Results There was statistically significant improvement of tics with respect to the Tourette's symptom severity scale.The reduced proportion of vocal tic scale was less than motor tic scale.One patient had transient incontinence after pallidotomy.Conclusions Pallidotomy provide a significant immediate and short term reduction of tic severity in intractable Tourette's syndrome.The long term effect of pallidotomy need to further studied.

关 键 词：立体定向 手术治疗 难治性抽动-秽语综合征 苍白球切开术 疗效 安全性 

分 类 号：R749.94[医药卫生—神经病学与精神病学]