颅内核团射频毁损治疗帕金森病若干问题探讨

目的：探讨和研究颅内射频毁损治疗帕金森病的方法，效果，术后并发症与反应等有关问题。方法：回顾性分析我院近一年来收治的104例帕金森病，应用CT解剖定位和微电极电生理记录细胞定位方法，行丘脑腹外侧核或／和苍白球腹后内侧部射频毁损治疗，术前，术后3月，半年和一年采用Webster记分，改善在1％－19％为好转，20％－59％为有效，60％以上为显效。结果：104例患中，术后3月内改善98例，总有效率达94．2％，6例症状改善不明显。67例随访6－12月，症状改善54例，有效率80．6％，16例出现一过性嗜睡，呃逆；2例出现一过性偏瘫，5例出现颅内少量出血，其中2例术后立即发生毁损点少量出血，3例术后6d内出现针道周围出血，1例术后3月因肺部感染死亡。结论：微电极电生理定位颅内核团毁损是治疗帕金森病安全的和有效的方法，但应注意掌握适应症，精确定位，提高治愈率。

Evaluation of Certain Aspects of Radiofrequency Thalamotomy and/or Pallidotomy for Treatment of Parkinson's Disease

Objective To explore the techniques and efficacy of radiofrequency lesioning of the thalamic and/or pallidal nuclei and to evaluate the possible postoperative reactions and complications in 104 patients with Parkinson's disease (PD). Methods Data of 104 cases with PD, who were treated by the radiofrequency lesioning of ventrolateral nuclei of the thalamus and/or posteroventral globus pallidus internus under the guidance of the CT scanning and microelectrode recording, were retrospectively analyzed. Results According to the Webster scoring the therapeutic results and follow-up findings were summarized as follow. Of the 104 cases, 98 were significantly improved within 3 months after the surgery and 6 were not. The effective rate was 94.2%. Follow-up (6-12 months) data of 67 patients showed that 54 (80.6%) experienced improvement in their symptoms. There were transient somnolence and/or hiccup in 16 cases, temporary hemiplegia in 2 and small amount of intracranial hemorrhage in 5 cases after the operation. One patient died of pulmonary infection 3 months after the surgery. Conclusions The thalamotomy and/or pallidotomy guided by the microelectrode techniques is the effective and safe method for treatment of PD, but the indication of this surgery should well be familiarized. Precise localization of the lesioning is of key importance to improving the therepeutic efficacy.