微电极导向核团毁损术和脑深部电刺激术治疗帕金森病的疗效分析

目的 观察微电极导向核团毁损术和脑深部电刺激术（DBS）治疗帕金森病的临床疗效。方法 对380例接受微电极导向立体定向核团毁损术和25例脑深部电刺激丘脑底核（STN—DBS）治疗的帕金森病患者进行随访和神经功能评估，分别获得术前、术后和DBS开启后1周、6个月、2年及5年的不同服药状态下统一帕金森病量表（UPDRS）评分资料，采用威尔科克森检验（Wilcoxontest），比较不同术后时间点UPDRS运动评分与术前评分的差异。结果 核团毁损术和DBS在术后1周、6个月及2年随访中均能明显改善术前帕金森病患者的UPDRS运动评分，减轻左旋多巴诱发的运动波动及异动症。在5年随访时间点上仅DBS治疗组较术前比较仍显示差异性。而且DBS组患者术后左旋多巴服药的剂量较术前减少。核团毁损组总体并发症的发生率为5．8％，永久性并发症的发生率为1．2％。DBS组未发生严重并发症。结论 核团毁损术和DBS两者被证实是中晚期帕金森病安全、有效的治疗方法，能显著改善术前帕金森病患者的UPDRS运动评分，减轻左旋多巴诱发的运动波动及异动症。STN—DBS较毁损术更具有独特的可控性、安全性和长效性。

Effect of microelectrode-guided ablative surgery and deep brain stimulation for the treatment of Parkinson''''s disease

Objective To investigate the effect of microelectrode-gnided ablative surgery and deep brain stimulation on Parkinson's disease.Methods Complete follow-up data were analyzed in 380 patients who underwent stereotaxic ablative surgery and 25 patients who underwent deep brain stimulation. Neurological condition was assessed by the Unified Parkinson's Disease Rating Scale (UPDRS) preoperatively with patients on and off medication or on DBS at 7 days,6 months,2 years and 5 years after surgery.Data from the 7 days,6 months,2 years and 5 years postoperative assessments were compared with preoperative values using Wilcoxon rank test.Results Both stereotactic ablative surgery and STN-DBS significant improved UPDRS motor scores and reduced L-dopa-induced motor fluctuations and dyskinesia in Parkinson's disease at 7 days,6 months,2 years after surgery.But only STN-DBS group demonstrated a significantly improvement in UPDRS motor scores at 5 years after surgery.And medication requirement was reduced also in the STN group.The rate of total complications is 5.6% and the rate of permanent complications is 1.2% in ablative surgery group.There were no serious intraoperative complications in STN -DBS group.Conclusion Both ablative surgery and STN-DBS appears to be safe and efficacious for the management of advanced PD.Both of them significantly improved UPDRS motor scores and reduced L-dopa- induced motor fluctuations and dyskinesia in PD.STN-DBS showed better safety,efficacy and long-term effect compared with ablative surgery.