背景:帕金森病患者第1次手术后肢体症状有所缓解,随病程进展或病情复发,肢体症状会加重,药物不能控制时需要行第2次手术来缓解症状.目的:探讨第2次手术治疗帕金森病患者单项症状改善率及其并发症的差异.设计:病例分析.单位:解放军第一五三中心医院神经外科和解放军第四军医大学唐都医院神经外科.对象:选择1997-10/2002-12到解放军第一五三中心医院神经外科和第四军医大学唐都医院神经外科就诊的原发性帕金森病患者387例,两次均在同一医院治疗350例,第1次在外院手术,第2次来本院治疗37例.两次手术间隔时间:半年以内36例,0.5～0.9年72例,1.0～1.9年108例,2.0～5.0年171例.方法:所有患者均在立体定向微电极引导下,采用靶点的影像学定位、微电极记录、微电极刺激探测靶点、射频电极刺激验证靶点,行分期双侧苍白球腹后内侧部或丘脑腹中间核毁损术,术前及术后1周在药物"开"状态下(药物开始起作用时,患者活动自如,处于"开"状态);"关"状态下(当药物失去作用时,患者的活动变得困难,处于"关"状态)进行统一帕金森病评定量表评分.主要观察指标:①帕金森病患者第2次手术单项症状改善率.②帕金森病患者第2次手术后并发症与第1次比较.结果:387例患者全部进入结果分析.①两次单项症状改善率:第2次手术单项症状改善率低于第1次(震颤95.4%,96.9%;僵直94.6%,95.1%;运动迟缓88.9%,92.3%;步态62.3%,67.1%;平衡65.1%,69.4%;异动症和痛性痉挛95.8%,98.0%),但经统计学处理,差异无显著性意义(P＞0.05).②两次手术后统一帕金森病评定量表评分均低于术前(P＜0.01).第2次手术开状态下统一帕金森病评定量表评分平均改善率为46.8%,关状态下平均改善率为53.5%,低于第一次手术(51.5%,61.6%).③帕金森病患者两次手术后并发症比较:第2次手术的特异性并发症,包括乏力感,流涎,音量降低,假性球麻痹,嗜睡,呃逆,尿失禁,尿潴留等明显高于第1次手术(P＜0.05).脑出血发生率低于第1次手术.结论:①第2次手术的单项症状改善率和统一帕金森病评定量表评分较低,可能是第2次手术时患者病情较第1次重,多处于帕金森病晚期的原因.②第2次手术的特异性并发症明显增高,可能与患者的年龄、病情、体质、手术方式、时间间隔有关.两次手术非特异性并发症发生率基本相同(脑出血、感染),说明第2次手术的出血风险并未增加.
揹景:帕金森病患者第1次手術後肢體癥狀有所緩解,隨病程進展或病情複髮,肢體癥狀會加重,藥物不能控製時需要行第2次手術來緩解癥狀.目的:探討第2次手術治療帕金森病患者單項癥狀改善率及其併髮癥的差異.設計:病例分析.單位:解放軍第一五三中心醫院神經外科和解放軍第四軍醫大學唐都醫院神經外科.對象:選擇1997-10/2002-12到解放軍第一五三中心醫院神經外科和第四軍醫大學唐都醫院神經外科就診的原髮性帕金森病患者387例,兩次均在同一醫院治療350例,第1次在外院手術,第2次來本院治療37例.兩次手術間隔時間:半年以內36例,0.5～0.9年72例,1.0～1.9年108例,2.0～5.0年171例.方法:所有患者均在立體定嚮微電極引導下,採用靶點的影像學定位、微電極記錄、微電極刺激探測靶點、射頻電極刺激驗證靶點,行分期雙側蒼白毬腹後內側部或丘腦腹中間覈燬損術,術前及術後1週在藥物"開"狀態下(藥物開始起作用時,患者活動自如,處于"開"狀態);"關"狀態下(噹藥物失去作用時,患者的活動變得睏難,處于"關"狀態)進行統一帕金森病評定量錶評分.主要觀察指標:①帕金森病患者第2次手術單項癥狀改善率.②帕金森病患者第2次手術後併髮癥與第1次比較.結果:387例患者全部進入結果分析.①兩次單項癥狀改善率:第2次手術單項癥狀改善率低于第1次(震顫95.4%,96.9%;僵直94.6%,95.1%;運動遲緩88.9%,92.3%;步態62.3%,67.1%;平衡65.1%,69.4%;異動癥和痛性痙攣95.8%,98.0%),但經統計學處理,差異無顯著性意義(P＞0.05).②兩次手術後統一帕金森病評定量錶評分均低于術前(P＜0.01).第2次手術開狀態下統一帕金森病評定量錶評分平均改善率為46.8%,關狀態下平均改善率為53.5%,低于第一次手術(51.5%,61.6%).③帕金森病患者兩次手術後併髮癥比較:第2次手術的特異性併髮癥,包括乏力感,流涎,音量降低,假性毬痳痺,嗜睡,呃逆,尿失禁,尿潴留等明顯高于第1次手術(P＜0.05).腦齣血髮生率低于第1次手術.結論:①第2次手術的單項癥狀改善率和統一帕金森病評定量錶評分較低,可能是第2次手術時患者病情較第1次重,多處于帕金森病晚期的原因.②第2次手術的特異性併髮癥明顯增高,可能與患者的年齡、病情、體質、手術方式、時間間隔有關.兩次手術非特異性併髮癥髮生率基本相同(腦齣血、感染),說明第2次手術的齣血風險併未增加.
배경:파금삼병환자제1차수술후지체증상유소완해,수병정진전혹병정복발,지체증상회가중,약물불능공제시수요행제2차수술래완해증상.목적:탐토제2차수술치료파금삼병환자단항증상개선솔급기병발증적차이.설계:병례분석.단위:해방군제일오삼중심의원신경외과화해방군제사군의대학당도의원신경외과.대상:선택1997-10/2002-12도해방군제일오삼중심의원신경외과화제사군의대학당도의원신경외과취진적원발성파금삼병환자387례,량차균재동일의원치료350례,제1차재외원수술,제2차래본원치료37례.량차수술간격시간:반년이내36례,0.5～0.9년72례,1.0～1.9년108례,2.0～5.0년171례.방법:소유환자균재입체정향미전겁인도하,채용파점적영상학정위、미전겁기록、미전겁자격탐측파점、사빈전겁자격험증파점,행분기쌍측창백구복후내측부혹구뇌복중간핵훼손술,술전급술후1주재약물"개"상태하(약물개시기작용시,환자활동자여,처우"개"상태);"관"상태하(당약물실거작용시,환자적활동변득곤난,처우"관"상태)진행통일파금삼병평정량표평분.주요관찰지표:①파금삼병환자제2차수술단항증상개선솔.②파금삼병환자제2차수술후병발증여제1차비교.결과:387례환자전부진입결과분석.①량차단항증상개선솔:제2차수술단항증상개선솔저우제1차(진전95.4%,96.9%;강직94.6%,95.1%;운동지완88.9%,92.3%;보태62.3%,67.1%;평형65.1%,69.4%;이동증화통성경련95.8%,98.0%),단경통계학처리,차이무현저성의의(P＞0.05).②량차수술후통일파금삼병평정량표평분균저우술전(P＜0.01).제2차수술개상태하통일파금삼병평정량표평분평균개선솔위46.8%,관상태하평균개선솔위53.5%,저우제일차수술(51.5%,61.6%).③파금삼병환자량차수술후병발증비교:제2차수술적특이성병발증,포괄핍력감,류연,음량강저,가성구마비,기수,애역,뇨실금,뇨저류등명현고우제1차수술(P＜0.05).뇌출혈발생솔저우제1차수술.결론:①제2차수술적단항증상개선솔화통일파금삼병평정량표평분교저,가능시제2차수술시환자병정교제1차중,다처우파금삼병만기적원인.②제2차수술적특이성병발증명현증고,가능여환자적년령、병정、체질、수술방식、시간간격유관.량차수술비특이성병발증발생솔기본상동(뇌출혈、감염),설명제2차수술적출혈풍험병미증가.
BACKGROUND: Although improvement could be achieved after the first operation, limb symptoms of patients would aggravate with the progress or reoccurrence of Parkinson disease (PD), thereby second operation would become necessary if symptom could not be controllel by medication.OBJECTIVE: To investigate the improving rate of symptoms and complications of patients with PD after the second operation.DESIGN: Case analysisSETTING: Neurosurgery Department of 153th Military Central Hospital and Neurosurgery Department of Tangdu Hospital Affiliated to the Fourth Military Medical University of Chinese PLA.PARTICIPANTS: Totally 387 primary PD patients were collected from Neurosurgery Department of 153th Military Central Hospital and Neurosurgery Department of Tangdu Hospital Affiliated to the Fourth Military Medical College of Chinese PLA from October 1997 to December 2002.Totally 350 patients received two operations in the same hospital, and other 37 patients received the first operation at other hospital and the second operation in our hospital. The intervals of two operations were within half a year in 36 cases, 0.5-0.9 year in 72 cases, 1.0-1.9 years in 108 cases and 2.0-5.0 years in 171 cases respectively.METHODS: Under the stereotactic microelectrode-guidance, the targets of all patients were subjected to iconographical orientation, microelectrode record, microelectrode stimulation and exploration and radio frequency microelectrode verification before just stage bilateral posteroventral pallidotomy (PVP) or thalamus ventral intermediate nucleus damage(TVIND),unified Parkinson's disease rating scale (UPDRS) was used at preoperative and postoperative "on" state (at the beginning of medication, patients move freely and stays in "on" state) as well as "off" state (when medication loss function, patients displays moving disability and stays in "off" state).complication between two operation .RESULTS: Data of 387 patients were remained in the results analysis.operation was lower than that of first operation (tremor 95.4%, 96.9%;rigidity 94.6%, 95.1%; bradykinesia 88.9%, 92.3%; gait 62.3%, 67.1%;balance 65.1%, 69.4%, akinesia and cramp 95.8%, 98.0%), but no diffor UPDRS were lower than that of preoperative scores (P ＜ 0.01). The mean total UPDRS scores improved by 46.8% in the "on" state and 53.5% in the "off" state after second operation, lower than that of first tive complications: The occurrenceof complications that was specific for the second operation including fatigue, salivation, reduced voice, fake bulbar paralysis, lethargy, hiccough, urinary incontinence, urinary retention were found higher than that of after the first operation (P ＜ 0.05).The occurrence of cerebral hemorrhage was also lower than that of after first operation.UPDRS were lower in the second operation, which may be due to that PD of postoperative complications which was specific for the second operation was obviously increased, which possibly associated with age, state of illness, constitution, operation type and interval between operations. But occurrence of non-specific postoperative complications was basically the same in two operations (cerebral hemorrhage and inflammation), suggesting that hemorrhage risk did not increased due to the second operation.
