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目的:总结丘脑底核脑深部刺激术(DBS)治疗帕金森病(PD)的经验。方法:自2000年3月至2007年12月应用DBS治疗PD 137例,其中单侧丘脑底核刺激68例,双侧丘脑底核刺激69例。术后1年(108例)、3年(43例)和5年(20例)分别进行PD评定量表(UPDRS)运动评分。结果:脉冲发生器开启时,在“关”期和“开”期状态下,术后1,3和5年UPDRS运动评分症状改善率分别为55.8%、53.4%和45.2%及22.5%、23.2%和20.4%。手术并发症主要有:肺部感染1例,脉冲发生器植入处胸部皮下感染1例,积液3例,头部刺激电极和皮下导线连接处皮肤破溃1例。二次手术调整刺激电极深度2例。无永久性并发症。结论:掌握适应证,规范手术操作和术中影像学验证是提高DBS疗效,降低并发症的关键。
Objective: To summarize the experience of treatment of Parkinson’s disease (PD) by subthalamic nucleus deep brain stimulation (DBS). Methods: From March 2000 to December 2007, 137 cases of PD were treated with DBS, including 68 cases of unilateral subthalamic nucleus stimulation and 69 cases of bilateral subthalamic nucleus stimulation. One year after surgery (108 cases), three years (43 cases) and five years (20 cases), PD assessment scale (UPDRS) was scored. Results: The improvement rates of UPDRS score at 1, 3, and 5 years after operation were 55.8%, 53.4% and 45.2% in the state of “OFF” and “ON” 22.5%, 23.2% and 20.4%. There were 1 cases of pulmonary infection, 1 case of subcutaneous infection in the chest at the implanter, 3 cases of effusion, and 1 case of skin ulceration at the junction of the head stimulating electrode and subcutaneous lead. Secondary surgery to adjust the depth of stimulation electrode in 2 cases. No permanent complications. Conclusion: It is the key to improve the curative effect of DBS and reduce the complication by mastering the indications, standardizing the operation and using intraoperative imaging.