分期双侧多靶点毁损治疗帕金森病

目的 探讨分期双侧多靶点毁损治疗帕金森病的疗效和适应证。方法 应用MR解剖定位及电极刺激靶点调整定位,对26例帕金森病患者实施分期双侧多靶点毁损治疗,两次手术平均间隔时间9个月。一侧单靶点毁损21例,一侧双靶点毁损24例,手术前后采用UPDRS、Hoehn和Yahr计分评价手术疗效。结果 本组随访期内均有显著疗效。其中行动迟缓改善87.0％(21/23),肢体僵硬改善90.9％(10/11),震颤消失86.7％(13/15),UPDRS改善80.8％(21/26),Hoehn和Yahr分级为0～Ⅰ级。手术后6例发生不同程度的语言障碍,其中1例随访至今未完全恢复,2例有轻度障碍,其余在短期内均恢复。结论 分期双侧多靶点毁损术是治疗帕金森病的有效方法,靶点精确定位是提高手术疗效,降低手术并发症的关键。

Staged Bilateral Stereotactic Multi-targets Lesion for Treatment of Parkinson Disease

Objective To investigate the indication and curative effect of staged bilateral multi-targets stereotactic lesion on treatment of Parkinson disease. Methods MR and elective stimulation was used to determine lesion targets in 26 patients with Parkinson disease. The average time interval between the two surgeries was 9 months (3-21 months) in 26 patients underwent the staged precedure. The unilateral single target was lesioned in 21 cases and the unilateral two targets in 24 cases. The patients were evaluated by the UPDRS, Hoehn and Yahn staging scale before and after the operation. Results During follow-up bradykinesia was improved in 89.7% of the patients, rigidity in 96.5%, tremor in 89.4%, and UPDRS total motor scores in 82.7%. Hoehn and Yahn staging scale was 0- I . Dysphasia occurred after the operation in the 6 patients, of whom, 3 recovered from dysphasia and 3 did not completely during the follow-up. Conclusions Staged bilateral stereotactic multi-targets lesion is an effective method of treatment of Parkinson disease. The precise placement of the lesion can enhance the treatment efficacy and decrease the complication of the operation.