丘脑底核电刺激术治疗帕金森病的疗效观察

目的 探讨丘脑底核（STN）行脑深部电刺激术（DBS）治疗帕金森病（PD）的疗效。方法 回顾性分析2016年1月至2017年9月收治的64例PD的临床资料，均采用STN-DBS治疗。术后均随访3个月，使用统一帕金森病评定量表（UPDRS-Ⅲ）评分评估疗效。结果 64例手术顺利完成，平均用时（4.39±1.01）h。共置入128根刺激电极，术后CT计算移位距离为0~1.89 mm，平均（0.91±0.42）mm。术前检测64例改善率在37.20%~82.54%，平均（55.36±5.62）%。术后抗PD药物的左旋多巴等效剂量明显低于术前（P<0.05）；术后开机状态下UPDRS-Ⅲ评分明显低于术前（P<0.05）。术后出现颅内积气29例、颅内出血2例、延伸导线移位3例、情绪改变、构音障碍2例、异动9例，末次随访时均完全改善或症状消失。结论 STN-DBS治疗PD，能有效改善病人运动功能，减少抗PD药物的使用，但围术期并发症风险高，临床应重视操作技巧。

Curative effect of deep brain stimulation of subthalamic nucleus on Parkinson’s disease

Objective To study the clinical effect of deep brain stimulation (DBS) of the subthalamic nuclei (STN) on Parkinson’s disease (PD). Methods Sixty-four patients with PD were treated by the STN-DBS from January, 2016 to September, 2017. The motor function, use of anti-PD drugs, intraoperative state and postoperative complications were analyzed in all the patients. Results The surgery was successfully completed in all the patients. One hundred and twenty-eight stimulating electrodes were ued. The successful rate of the one-time puncture of the bilateral STN was 85.94% (55/64). The bilateral STN signals were clearly recorded by the intraoperative microelectrodes in 51 patients. The unilateral STN signals was not recorded in 13 patients, in whom the significant effect of the stimulation of STN were observed. The mean rate of symptoms improvement was (55.36±5.62)% in 64 patients. The levodopa equivalent dose taken by every patient was significantly lower after the surgery than that before the surgery (P<0.05). The UPDRS-Ⅲ scores under the state of medication and non-medication were significantly lower after the surgery than those before the surgery (P<0.05). The micro-destructive effects were observed in 26 patients in whom the symptoms were relieved after the surgery. The postoperative complications including the intracranial pneumatosis (45.31%, 29/64), intracranial hemorrhage (3.13%, 2/64) and so on disappeared during the following-up for postoperative 3 months. Conclusions The STN-DBS can improve of motor function, and reduce the dose of anti-PD drugs, but it has high risks of postoperative complications, and the clinical attention should be paid to the operative manipulation the operative manipulation in the patients with PD.