双侧立体定向手术治疗帕金森病的疗效分析

目的：分析帕金森病双侧立体定向手术的术式与疗效，并发症的关系。方法：58例帕金森病患者进行了双侧手术治疗，其中分期双侧苍白球腹后部毁损术（PVP）或腹中间核（Vim)毁损术41例，分期一侧PVP或Vim毁损术，另一侧丘脑底核（STN）或Vim脑深部刺激术（DBS）6例；同期双侧PVP5例，同期双侧STN DBS4例，同期一侧PVP,另一侧STN DBS2例，平均随访6．2个月。:UPDRS结核平分显示双侧术后帕金森病症状均有不同程度改善，但以同期双侧STN DBS效果最佳，无并发症。双侧毁损术并发症较高，尤其是分期双侧Vim毁损术和同期双侧PVP。结论：双侧DBS是具有双侧症状的帕金森病患者立体定向手术治疗的最佳术式，双侧毁损术并发症较高，应慎重采用。

Clinical evaluation of bilateral stereotactic operation in treatment of Parkinson disease

Objective: To study the effectiveness and complications of bilateral stereotactic surgical procedures in treatment of Parkinson disease(PD). Methods:Fifty eight patients with PD underwent bilateral stereotactic surgical procedures. There was staged bilateral pallidotomy or thalamotomy in 41 patients,staged pallidotomy or thalamotomy on one side and subthalamic nucleus(STN) or ventral intermediate(Vim) stimulation on the other side in 6 patients, simultaneous bilateral pallidotomy in 5 patients, simultaneous bilateral STN stimulation in 4 patients and simultaneous pallidotomy on one side and STN stimulation on the other side in 2 patients. The mean follow up duration was 6.2 months. Results:According to unified PD rating scale, all the bilateral procedures improved patients symptoms, but the degree of improvement was higher with simultaneous bilateral STN stimulation than with other procedures. Bilateral ablative procedures had a higher risk of postoperative complications. Conclusion:Bilateral deep brain stimulation is the first choice for PD patients with bilateral symptoms,while bilateral ablative procedures has a high complication rate, which should be used with caution.