帕金森病96例给予微电极引导立体定向脑内核团毁损术治疗的临床观察

86例帕金森病立体定向微电极导航术后1～2年临床疗效观
察
唐继全;唐春果
【期刊名称】《四川省卫生管理干部学院学报》
【年(卷),期】2002(021)002
【摘要】目的：了解立体定向微电极导航手术治疗帕金森病的远期疗效。

方法：
选我院术后1～2年有效回访的86例帕金森病患者进行统计分析。

结果：86例患者术后1～2年继续好转，稳定恢复82例(95.4％)；4例恶化，其性别、年龄、类型、症状、毁损侧与疗效无关。

结论：术后1～2年有效率95.4％，无效率4.6％，而效果不受年龄等因素的影响。

【总页数】2页(P103-104)
【作者】唐继全;唐春果
【作者单位】成都中医药大学附属医院细胞刀中心,四川,成都,610072;成都中医药
大学附属医院细胞刀中心,四川,成都,610072
【正文语种】中文
【中图分类】R742.5
【相关文献】
1.微电极导向立体定向术治疗帕金森病术后并发症的护理 [J], 刘玉梅
2.微电极引导立体定向功能核团毁损术治疗帕金森病的临床分析 [J], 娄金峰;常克亮;耿晓腾;牛光明;陶胜忠
3.微电极引导立体定向脑内核团毁损术治疗帕金森病临床观察 [J], 娄金峰;牛光明;陶胜忠;常克亮;耿晓腾
4.微电极引导立体定向治疗帕金森病术后康复护理 [J], 李玉芬;乔小茹
5.微电极导向立体定向技术行脑内核团毁损和脑深部电刺激治疗帕金森病的效果观察 [J], 马如钧;张伟;刘永;孙伯民
因版权原因，仅展示原文概要，查看原文内容请购买。

文章编号:100025404(2001)1021209203论著微电极引导立体定向手术治疗帕金森病71例报告崔高宇,冯　华,王宪荣,吴国材,吴　南,陈　志 (第三军医大学附属西南医院神经外科,重庆400038) 提　要:目的　介绍微电极引导立体定向手术治疗帕金森病的方法和结果。

方法　采用CT/MRI双重影像学定位,术中行微电极记录技术靶点监测,对71例原发性帕金森病患者行丘脑腹外侧核、苍白球腹后内侧部射频毁损,其中12例A型患者行单侧丘脑腹外侧核毁损术,1例A型患者行双侧丘脑腹外侧核毁损术;51例行苍白球腹后内侧部毁损术,1例行同期双侧苍白球腹后内侧部毁损术,1例行同期单侧苍白球腹后内侧部及丘脑腹外侧核毁损术,5例行延期双侧苍白球腹后内侧部毁损术。

术前及术后12个月应用M otor UPDRS量表进行评价。

结果　12例单侧、1例双侧丘脑腹外侧核毁损术后12个月,肢体静止性震颤完全或基本消除,其中2例下颌静止性震颤有明显缓解;58例行苍白球腹后内侧部毁损术(6例双侧),术后静止性震颤、僵直、运动迟缓均有较大改善。

结论　微电极引导立体定向手术是治疗帕金森病的有效手段之一,但是仍有可能出现严重的并发症。

关键词:帕金森病;立体定向手术;微电极记录 中图法分类号:R35;R651;R745.7 文献标识码:AT reatment of71cases of P arkinson’s disease by microelectrode2guided stereotactic pal2 lidotomy and thalamotomyC UI G ao2yu,FE NG hua,W ANG X ian2rong,W U G uo2cai,W U Nan,CHE NG Zhi(Department of Neurosurgery,S outhwest H ospital,Third M ilitary M edical University,Chongqing400038,China) Abstract:Objective　T o report the technique and result of treating Parkins on′s disease by microelectrode2guided stereotactic pallidotomy and thalam otomy.Methods　The localization of target was achieved by MRI and CT scans.Pallidal and thalamal target sites were supervised by micro2 electrode recording technique in71patients with Parkins on′s disease.Am ong all the patients,12cases of type A were underg one unilateral ventrolat2 eral thalam otomy,1contem porary bilateral ventrolateral thalam otomy,51unilateral posteroventral pallidotomy,1contem porarybilateral posteroventral pallidotomy,1contem porary unilateral ventrolateral thalam otomy and posteroventral pallidotomy and5postponed bilateral posteroventral pallidotomy. Evaluation of UPDRS m otor score was made,before and12m onths after the operation.Re sults　Within12m onths after the operation,trem or was res olved com pletely or nearly com pletely in12patients who had been underwent unilateral and1bilateral ventrolateral thalam otomy,and mandible trem or had been im proved in2patients.T rem or,rigidity,bradykinesia were dramitically improved in58patients underwent posteroventral pallidoto2 my,am ong them,6had been underg one bilateral posteroventral pallidotomy.Intracerebral hem orrhage was observed in1patient.Conclusion　Mi2 croelectrode2guided stereotactic pallidotomy and thalam otomy are effective measures for the treatment of Parkins on′s disease,but probably may bring about serious com plications. K ey w ords:Parkins on′s disease;stereotactic surgery;microrecording 目前,用微电极引导的立体定向功能神经外科手术进行神经核团毁损已经成为治疗帕金森病的有效手段,我科从1998年10月至1999年11月手术治疗原发性帕金森病71例,现做回顾性研究。

微电极引导立体定向脑内核团毁损术治疗帕金森病临床观察娄金峰;牛光明;陶胜忠;常克亮;耿晓腾【期刊名称】《中国实用神经疾病杂志》【年(卷),期】2015(000)009【摘要】目的：研究微电极引导下立体定向核团毁损术治疗帕金森病的临床效果分析。

方法我院106例微创外科手术治疗帕金森病患者的临床资料，显效（含显效及特别显效）90例（84.9％），有效16例（15.1％），总有效率100％。

分别获得微创治疗术前、术后不同服药状态下帕金森病联合评分量表（U PDRS ）的评分，比较微创手术治疗前后U PDRS运动评分之间的差异。

结果颅内核团毁损术在术后3个月、6个月及1 a的随访中均能有效改善帕金森患者术后U PDRS 运动评分，同时患者术后口服抗帕金森病类药物用量较术前可见不同程度的减少。

结论微电极引导立体定向脑内核团毁损治疗帕金森病疗效满意，能显著改善帕金森病患者的U PDRS 运动评分，精确定位是手术成功的关键，微电极记录可提高手术的准确性。

【总页数】2页(P82-83)【作者】娄金峰;牛光明;陶胜忠;常克亮;耿晓腾【作者单位】郑州大学第二附属医院功能神经外科郑州 450014;郑州大学第二附属医院功能神经外科郑州 450014;郑州大学第二附属医院功能神经外科郑州450014;郑州大学第二附属医院功能神经外科郑州 450014;郑州大学第二附属医院功能神经外科郑州 450014【正文语种】中文【中图分类】R742.5【相关文献】1.微电极引导立体定向功能核团毁损术治疗帕金森病的临床分析 [J], 娄金峰;常克亮;耿晓腾;牛光明;陶胜忠2.微电极引导立体定向脑内核团毁损术治疗帕金森病 [J], 简国庆3.微电极导向立体定向技术行脑内核团毁损和脑深部电刺激治疗帕金森病的效果观察 [J], 马如钧;张伟;刘永;孙伯民4.微电极和立体定向定位脑内核团毁损治疗帕金森病386例 [J], 陈鸿耀;田磊;沈文珍5.微电极导向立体定向脑内核团毁损治疗帕金森病 [J], 陈鸿耀;田磊;沈文珍因版权原因，仅展示原文概要，查看原文内容请购买。

立体定向脑核团毁损治疗帕金森病【摘要】立体定向射频毁损治疗帕金森病，是一种有效的外科手术方法，但由于个体差异较大，目前各定位方法难以达到精确定位，加之靶点最理想的毁损灶位置和大小尚不完全清楚等原因，术后常出现一些并发症。

作者就立体定向脑内核团毁损的应用解剖基础、靶点的定位、手术并发症等内容进行综述。

【关键词】立体定向; 脑核团毁损; 帕金森病; 综述[Abstract] It is an effective surgical method to treat Parkinson disease with stereotactic radiofrequency.However, It is difficult to achieve precise location because of some reasons such as individual differences, the best target of the best location and size of lesions is unclear until now. Postoperative complications often arise. This review include the anatomical basis of the brain cerebral nucleus which used by stereotactic radiofrequency, the location of the target, and the postoperative complications, etc.[Key words] sterotactic; radiofrequency lesion; Parkinson disease; review帕金森病(Parkinson disease, PD)的外科治疗是伴随着对功能结构和运动障碍疾病的病理生理机制深入了解和神经外科技术不断进步而发展起来的。

微电极引导立体定向治疗帕金森病围手术期护理帕金森病是一种以震颤、肌肉僵直、运动活动-启动困难和姿势反射丧失为特征的疾病［1］。

临床资料一般资料：本组43例，男27例，女16例；年龄38～76岁，平均62岁；病程2～20年，平均9年。

临床表现A型(震颤型)11例，B型(僵直型)13例，AB型(震颤僵直型)19例，均经过安坦或美多巴系药物治疗，症状不能控制而采用微电极立体定向毁损治疗。

A型11例震颤均消失，B型13例僵直均明显改善，AB型19例震颤消失，僵直明显改善。

手术方法简介：①定位：脑立体定向仪头环Leksell-G固定于颅骨上，用MRI进行影象学定位。

头颅MRI薄层扫描，将图像扫描传输至立体定向手术计划系统，计算核团靶点坐标。

②手术：病人仰卧于手术床上，定向仪头环通过适配器固定于手术床以保持稳定。

局麻下，一次切开头皮，长3～4cm，局部钻孔电灼并“十”字剪开硬脑膜，形成直径约2mm软膜缺损，将立体定向仪坐标调整至靶点的位置，并进行校准，安装立体定向仪，用微电极记录和粗电极刺激的生理方法，验证靶点后，进行毁损。

护理术前护理：①心理护理：帕金森病人由于长期疾病的折磨，易发脾气，易多疑，护理人员多关心他们以取得病人的信任，采集病人的资料，找出主要护理问题，对症处理，调动家属的积极性，要求家属密切配合工作，帮助患者合理安排生活，帮助患者全面了解并正确认识。

②做好健康宣教，术前训练病人用非语言的方式表达自己的体会，术中重要的配合是看视觉刺激和视野监测，与手术的成功与否及避免偏盲并发症具有重要意义。

③术前常规准备。

④核磁定位准备。

术中配合：帕金森多为老年病人，手术需经历开颅、微电极介入、毁损电极推进、数据分析、射频治疗等，每个步骤均要病人密切配合，但反复的肢体定位运动不仅引起病人的烦躁，还会消耗病人的体力，使其失去耐性。

护理人員要鼓励患者，耐心解释，指导病人准确反映自己的感觉并说明其配合的重要意义，并了解其需求。

微电极引导立体定向功能核团毁损术治疗帕金森病的临床分析娄金峰;常克亮;耿晓腾;牛光明;陶胜忠【期刊名称】《重庆医学》【年(卷),期】2016(45)12【摘要】Objective To study the application of microelectrode stereotactic functional nucleus lesioning operation in the treatment of Parkinson′s disease(PD) ,and to explore its clinical value .Methods The clinical data in 84 cases of PD treated with‐out using the microelectrode stereotactic functional nucleus lesioning operation(observation group) and 74 cases of PD treated by u‐sing microelectrode guided stereotactic functional nucleus lesioning in our hospital were retrospectively analyzed .At the same time the Unified Parkinson′s Disease Rating Scale (UPDRS) scores before the nucleus lesioning and at postoperative different medication states were obtained in the observation and the control group .Furthermore the difference of the UPDRS motor scores before and af‐ter operation were compared between the two groups .Results The UPDRS motor scores at postoperative 3 ,6 months and 1 year in the observation group were significantly improved compared with beforeoperation(P<0 .05) ,meanwhile the postoperative anti‐PD drug dosage was significantly decreased compared with before operation(P<0 .05) .Among them ,70 cases(83 .3% ) in the control group were obviously effective ,14 cases(16 .7% ) were effective ,and the total effective rate was 100% ;while62 cases(83 .7% ) in the observation group were obviously effective ,12 cases (16 .3% ) were effective ,and the total effective rate was 100% .The differ‐ence in improving the UPRDS motor sco res before and after operation had no statistical difference between the twogroups(P>0 .05) .Conclusion Stereotactic nucleus lesioning in treating PD has satisfactory effect and can significantly improve the UPRDS motor scores .Accurate positioning is the key to the operation success ,whether microelectrode recording can significantly improving the operation accuracy needs further discussion .%目的：研究微电极在立体定向功能核团毁损治疗帕金森病（PD ）的应用，并探讨其临床价值。

微电极导向立体定向技术行脑内核团毁损和脑深部电刺激治疗帕金森病的效果观察马如钧;张伟;刘永;孙伯民【期刊名称】《中国医药导刊》【年(卷),期】2012(14)8【摘要】Objective:To observe the microelectrode oriented stereotactic technology do brain damage and kernel group deep brain electrical stimulation treatment effect of Parkinson's disease. Methods:Choose from year 2008 June 2010 - June 216 cases of patients with Parkinson's disease, according to the different treatment methods are divided into two groups, the microelectrode oriented stereotactic technology do brain damage kernel group 180 patients group for damage, the deep brain stimulation (DBS) electric treatment of the 36 patients for DBS group; All of the patients were followed up for 6 to 12 months, the observation group 2 after treatment, symptoms improved and UPDRS motion score. Results:Two groups after treating motion score symptoms improved shows, in a state of damage, improvement of symptoms in 70 cases, accounting for 38.89%; Close state, the improvement of symptoms in 96 cases, accounting for 63.33%; DBS group in the open state, the symptoms improve 10 patients (27.78%; Close state, the improvement of symptoms (19 cases), 52.78%; Two groups of comparisons no significant differences, no statistical significanceP>0.05. DBS group in January 23 cases aftersymptoms improve, not adjust the parameters, 13 cases of symptoms after treatment not completely control, again after the adjustment parameters symptoms complete control, the total effective rate of 100%; Damaged group were followed up for 6 to 12 months, 101 cases were markedly effective, accounted for 56.11%; Effective in 65 cases, accounting for36.11%; Invalid in 14 cases, 7.78%, the total effective rate was 92.22%, two groups of comparisons with significant difference, there is statistical significance P<0.05. Damage of adverse reactions happen group in 7 cases, a rate of 3.89%; DBS group no obvious adverse reaction, two groups of comparisons with significant difference, there is statistical significanceP<0.05.Conclusion:The deep brain stimulation (DBS) is the treatment of Parkinson' s disease new technology, preoperative symptoms in patients with according to set up a reasonable parameters, and at the same time in the follow-up process can be according to the patient' s symptoms improved on the adjustment, make clinical symptoms get effective control, and less postoperative complications, and treatment of Parkinson' s disease is safe and effective operation method.%目的:观察微电极导向立体定向技术行脑内核团毁损和脑深部电刺激治疗帕金森病的效果.方法:选择我院2008年6月～2010年6月216例帕金森病患者,按照治疗方法不同分为二组,采用微电极导向立体定向技术行脑内核团毁损180例患者为毁损组,采用脑深部电刺激(DBS)治疗的36例患者为DBS组;所有患者均随访6～12个月,观察二组治疗后症状改善情况及UPDRS运动评分.结果:二组治疗后运动评分症状改善情况显示,毁损组在开状态下,症状改善70例,占38.89%;关状态下,症状改善96例,占63.33%;DBS组在开状态下,症状改善10例,占27.78%;关状态下,症状改善19例,占52.78%;二组比较差异无显著性,无统计学意义P＞0.05.DBS组中23例在1月后症状改善,未调整参数,13例因治疗后症状未完全控制,经再次调整参数后症状完全控制,总有效率100%;毁损组随访6～12个月,显效101例,占56.11%;有效65例,占36.11%;无效14例,占7.78%,总有效率为92.22%,二组比较差异具有显著性,有统计学意义P＜0.05.毁损组中共发生不良反应7例,发生率为3.89%; DBS组无明显不良反应,二组比较差异具有显著性,有统计学意义P＜0.05.结论:脑深部电刺激(DBS)是治疗帕金森病的新技术,术前根据患者的症状合理设置参数,同时在随访过程中可根据患者的症状改善情况进行调节,使临床症状得到有效的控制,且术后并发症少,是治疗帕金森病安全有效的手术方法.【总页数】3页(P1333-1334,1336)【作者】马如钧;张伟;刘永;孙伯民【作者单位】解放军第85医院神经外科,上海,200052;解放军第85医院神经外科,上海,200052;解放军第85医院神经外科,上海,200052;上海瑞金医院功能神经外科,上海,200025【正文语种】中文【中图分类】R651.1【相关文献】1.微电极导向脑内核团定向毁损术治疗帕金森病 [J], 况建国;邹安琪;江志群;洪涛;郝向阳;徐庚生;刘泉开2.微电极引导立体定向脑内核团毁损术治疗帕金森病临床观察 [J], 娄金峰;牛光明;陶胜忠;常克亮;耿晓腾3.帕金森病CT表现及微电极导向脑内核团毁损术后CT影像分析 [J], 黄祖平;王维;李秋云;罗晓4.微电极导向脑内核团毁损术治疗帕金森病 [J], 陈焕林;邵立民;邵永良;黄红星;曾其昌;匡卫平5.微电极导向立体定向脑内核团毁损治疗帕金森病 [J], 陈鸿耀;田磊;沈文珍因版权原因，仅展示原文概要，查看原文内容请购买。