摘要
目的 客观评估双侧苍白球腹后部切开术(BPVP)治疗原发性帕金森病 (PD)的疗效 ,探讨其必要性和利弊。 方法 46例具双侧PD症状的患者接受了微电极导向的双侧苍白球手术。其中 ,2 0例CBPVP ,2 6例SBPVP。SBPVP又分为首次手术SBPVP1和第二次手术SBPVP2 ,二者间隔 3～ 12个月 ,平均 6 5± 2 4个月。患者的Hohn和Yahr评分均在 2 0以上。采用PD病情评估的UPDRS方法 ,对手术前后和“开、关”4种状态进行评分。统计分析BPVP手术前后症状改善情况的组内差异 ,CBPVP、SBPVP1和SBPVP2之间的组间差异 ,以及并发症的发生类型和高低情况。 结果 CBPVP、SBPVP1以及SBPVP2均明显改善患者的整体病情和典型症状 (震颤、僵直和行动迟缓 ,P <0 0 0 1) ,它们对“关”状态的改善总是高于对“开”状态的改善。与SBPVP1或SBPVP2相比 ,CBPVP有着较高的改善率 ,但未达到统计学差异。分期手术对UPDRS的第 4部分即左旋多巴类药物治疗副作用的改善明显低于同期手术 (P <0 .0 5 )。手术未发生脑出血、视野缺损和肢体力弱等苍白球手术较常见的并发症 ,也未发现与双侧手术相关的认知障碍。CBPVP组 1例患者术后明显语音低下、吞咽困难 ,SBPVP组 2例患者出现语音低下。 3个月后随访 ,以上并发症有所缓解但未完全恢复。 结论 对?
Objective To clarify the benefits and risks of patients undergoing bilateral posteroventral pallidotomy (BPVP) for patients with idiopathic Parkinson′s disease (PD) and the differences between contemporaneous BPVP (CBPVP) and staged BPVP (SBPVP). Methods Twenty patients underwent microelectrode guided CBPVP and 26 SBPVP for bilateral PD symptoms. The data were retrospectively reviewed. Unified Parkinson′s Disease Rating Scale (UPDRS) was used to evaluate the effects of these operations. Results BPVP, either CBPVP or SBPVP, significantly improved patients′ bilateral PD symptoms (P<0 001). The improvement was consistently higher in “off” state than in “on” state. No statistical difference was observed in the improvement percentages of CBPVP, SBPVP1 and SBPVP2. CBPVP contributed greatly to L dopa induced side effects (part IV). BPVP, SBPVP1, and SBPVP2 significantly improved cardinal parkinsonian signs but no difference was found among them. One patient after CBPVP developed hypophnia and swallowing problem, while 2 patients after SBPVP sustained hypophnia. These conditions were improved 3 months later. Conclusionsly improve bilateral signs of PD. It is safer than bilateral thalamotomy. CBPVP is applicable to some patients. BPVP may not cause mental impairment but shows a higher incidence rate of hypophnia. The practice of BPVP requires a refined surgical technique and a better understanding of pathophysiology of the basal ganglia.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2000年第3期165-168,共4页
Chinese Journal of Surgery
基金
国家科委资助项目!(96920060517)
北京市科委资助项目!(953304001)
