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目的 ;探讨立体定向多靶点毁损治疗帕金森病(PD)的方法和影响疗效的因素。方法应用南京麦迪柯科技公司98-3型脑立体定向计算机辅助规划手术系统,螺旋CT薄层扫描解剖定位,对37例PD患者进行苍白球和(或)丘脑多靶点毁损手术,分析术后患者的靶点影像学改变和影响临床疗效的因素。结果随访3~5年,按PD联合评分标准(UPDRS)进行评分,显效24例(64.86%),改善9例(24.32%),无效4例(10.81%)。3年后复发再手术3例(8.1%),3例双侧手术,近期效果满意。并发症:术后3天内对侧肢体先肌痉挛后轻度偏瘫者4例(11.0%),远期出现肢体麻木、语音低、智能减退者4例(10.81%)。CT/MRI复查靶点毁损灶消失3例(8.10%),靶点毁损灶稳定34例(91.89%),无其它并发症及死亡。结论单靶点毁损且毁损灶小复发率高,多靶点毁损远期并发症高,靶点毁损术治疗PD近期疗效好,远期差。
Objective To investigate the methods of stereotactic multi-target lesions in the treatment of Parkinson’s disease (PD) and the factors influencing the curative effect. Methods A total of 37 cases of PD patients underwent surgery of globus pallidus and / or thalamic multi-target debridement by using the computer-aided planning system of 98-3 brain-oriented stereotactic computer-aided planning system and spiral CT scan by Nanjing Medico Technology Company. The patient’s target imaging changes and factors that affect the clinical efficacy. Results The patients were followed up for 3 to 5 years. According to the PD combined score (UPDRS) score, 24 cases (64.86%) were significantly improved, 9 cases (24.32%) improved and 4 cases (10.81%) ineffective. Three years after the recurrence of surgery in 3 cases (8.1%), 3 cases of bilateral surgery, the recent results were satisfactory. Complication: 4 cases (11.0%) had mild hemiplegia after contralateral limb spasticity in 3 days after operation. There were 4 cases (10.81%) of numbness, low voice and low intelligence in the long term. In CT / MRI, 3 cases (8.10%) disappeared the target lesion and 34 cases (91.89%) had the target lesion stable without any other complication and death. Conclusions The single target is damaged and the recurrence rate of the lesion is high. The long-term complications of the multi-target lesion are high. The short-term therapeutic effect of the target lesion is good and the long-term is poor.