立体定向苍白球毁损术的手术并发症

目的 全面和系统地分析苍白球毁损术并发症，并对并发症进行适当的分类。方法 统计1305例帕金森病患者，将并发症分为Ⅰ类并发症和Ⅱ类并发症。Ⅰ类并发症指并发症的发生与手术的定位不准确有关，包括：视野缺损、偏瘫。Ⅱ类并发症则指并发症的发生与手术的创伤有关，目前不能完全用定位偏差来解释，它包括：乏力感、流涎、吞咽困难、呃逆、音量降低、嗜睡、癫痫发作、肢体失用、精神错乱、脑出血、昏迷。结果 Ⅰ类并发症视野缺损和偏瘫的发生率分别为0.09%和0.26%，Ⅱ类并发症术后乏力达25.6%，音量减低11.6%，嗜睡12.6%，呃逆11.9%，流涎7.8%，吞咽困难4.1%。分期双侧苍白球毁损术发生率较高，分别为乏力47.6%，流涎26.6％，吞咽困难16.9%，音量降低20.5%。脑出血的17例。肢体失用3例，不明原因昏迷2例，术后短暂精神错乱4例。结论 苍白球毁损术的并发症种类较多，尽管多数并发症并非严重并发症，但是，值得注意的是苍白球毁损术的并发症在乏力、流涎、音量降低发生率较高，双侧手术要慎重，尤其是同期双侧苍白球毁损术。微电极手术的脑出血发生几率仍是较低的，是可以接受的低风险。

Complications stereotactic pallidotomy

Objective To systemically report cmplications in pallidotomy and classify complications.Methods We analysis 1305 patients after microelectrode guided pallidotomies at our center, and classified complications into complication I and complication II. The complication I is depended on accuracy of localization, whereas the complication II is associated with damage from operations. The complication I includes visual field defect and hemiplegia. The complication II icludes fatigue, sleepiness, drooling, dysphagia, dysarthria, singultus, hemorrhage, seizer, apraxia, coma, infection, mental confusion. Results For complication I, the incidences of visual field defect and hemiplegia are 0.09% and 0.26% respectively. For complication II, the incidence of fatigue is 25.6%, sleepiness is 12.6%, drooling is 7.8%, dysphagia is 4.1%, dysarthria is 11.6%, singultus is 11.9%. After staged pallidotomies, the incidences of fatigue, sleepiness, drooling and dysphagia are 47.6%, 20.5%, 26.6% and 16.9% respectively. There are hemorrhage in 17 patients, apraxia in 3 patients, coma in 2 patients, mental confusion in 4 patients.Conclusions There are a lot of kinds of complications in pallidotomy. Though most of them are not serious, the incidences of fatigue, drooling, dysarthria are relatively high. For this reason, bilateral staged pallidotomy should be well evaluated before operation. Bilateral contemporaneous pallidotomy is undesirable. The incidence of hemorrhage in microelectrode-guided pallidotmy is acceptable because of low incidence.