摘要
目的总结分期双侧丘脑及苍白球核团毁损治疗原发性帕金森病（PD）的疗效，探讨其有效性及安全性。方法安徽医科大学附属省立医院神经外科自1998年2月至2008年5月对已行一侧核团毁损术的19例患者施行微电极导向立体定向对侧丘脑及苍白球核团毁损治疗，其中16例患者一期行丘脑腹中间核（Vim核）毁损，二期行对侧苍白球内侧部（Gpi核）毁损，同时加做Vim核小灶毁损。3例患者一期行Gpi核毁损，二期行对侧Gpi核毁损及vim核小灶毁损。采用PD国际统一评分量表（UPDRS）对患者术前、术后1周“开”、“关”两种状态进行评分，分析术后症状改善情况及并发症的发生。结果所有患者的整体病情和典型症状（震颤、僵直、行动迟缓）均得到明显改善，二期Gpi核毁损术对缓解僵直明显，加做Vim核小灶毁损，震颤缓解满意。2例患者术后出现构音困难．其中1例伴吞咽困难。3个月后症状缓解。结论对双侧症状均较严重的PD患者，只要严格掌握适应征，选择合适的靶点，严格控制毁损灶大小，分期双侧丘脑及苍白球核团毁损治疗是一种安全有效的方法。
Objective To investigate the efficacy and safety of staged bilateral thalamus and globus pallidus stereotactic lesioning in patients with idiopathic Parkinson＇s disease （PD）. Methods Nineteen PD patients, admitted to our hospital from February 1998 to May 2008 and received staged bilateral thalamus and globus pallidus stereotactic lesioning under the stereotactic microelectrode-gnidance, were chosen in our study; 16 of them had a primary operation with ventral intermediate （Vim） stereotactic lesioning, and other 3 had globus pallidus-intemal segment （Gpi） stereotactic lesioning; second-staged operation with contralateral Gpi and small focal of Vim nucleus stereotactic lesioning was performed on all patients. The unified Parkinson disease rating scale （UPDRS） was used to estimate the ＂switch-on＂ and ＂switch-off＂ states of each patient before operation and 1 week after operation. The improvement of symptoms and the happening of complications after the operation were analyzed. Results Improvements were observed in all the 19 patients postoperatively in terms of stiffiaess and tremor. Stiffness was significantly alleviated after lesioning of Gpi, and tremor was markedly relieved after the Vim nucleus small focal lesioning. Two patients had dysarthria postoperatively, and 1 of them had dysphagia; the symptoms were alleviated 3 months after the operation. Conclusion Staged bilateral thalamus and globus pallidus stereotactic lesioning is a safe and effective surgical treatment for PD patients with bilateral severe symptoms. Controlling the indications and the size of lesioning strictly, and selecting the targets appropriately are of vital importance to the operation.
出处
《中华神经医学杂志》
CAS
CSCD
北大核心
2012年第6期549-551,共3页
Chinese Journal of Neuromedicine
关键词
帕金森病
丘脑腹中间核
苍白球内侧部
立体定向
Parkinson＇s disease
Ventralis intermedius nucleus
Globus pallidus-internal segment
Stereotaxis
