中脑加扣带回联合毁损术治疗中枢性疼痛的应用研究

目的研究对侧中脑加双侧扣带回前部联合毁损术治疗中枢性疼痛的临床应用。方法中枢性疼痛6例,包括丘脑或桥脑梗死3例、丘脑出血2例、脊髓损伤1例。局麻下联合毁损疼痛对侧中脑脊髓丘脑束加双侧扣带回前部3例,联合毁损对侧三叉丘系加双侧扣带回前部3例。采用直观模拟疼痛量表(visualanalogscale,VAS)和McGill疼痛问卷量表(McGillpainquestionnaire,MPQ)分别在术前和术后进行疼痛评分,同时记录手术前后患者使用镇痛剂的种类和最大剂量。将术后不同时间的VAS、MPQ评分与术前的评分进行比较,采用小样本自身配对t检验。结果术后患者疼痛基本消失,全部不再使用麻醉镇痛剂,3个月以内止痛效果满意,VAS评分和MPQ评分较术前均显著降低(P<0.01)。1例术后13周疼痛逐渐复发,另5例术后6个月止痛疗效稳定,VAS评分和MPQ评分较术前明显降低(P<0.01)。无严重并发症发生。结论对侧中脑加双侧扣带回前部联合毁损术能有效消除中枢性疼痛,超过1年的长期疗效有待进一步观察。

Cooperation of Mesencephalotomy and Bilateral Anterior Cingulotomy for the Treatment of Central Pain

Objective A study on the cooperation of mesencephalotomy and bilateral anterior cingulotomy for the treatment of central pain. Methods Six patients with central pain including 3 cases of thalamus or pontine infarction, 2 cases of thalamus haemorrhage, 1 cases of spinal cord injure, were treated using the cooperation of mesencephalotomy and bilateral anterior cingulotomy. The visual analog scale (VAS) and the McGill pain questionnaire (MPQ) were used for preoperative and postoperative evaluation of the pain status of each patient. Statistical analyses were conducted using paired-samples t test. Results The short-term (3 months) follow-up results indicated a significant reduction in patients' pain scales( P <0.01). In the long-term follow-up period, pain recurred in 1 patient treated in 13 weeks. Other 5 patients had excellent pain relieving effect in 6 months after operation. There were no serious complication and surgery-related mortality. Conclusion The cooperation of mesencephalotomy and bilateral anterior cingulotomy is a effective means for relieving central pain.