CAJ | 학술논문

目的探讨丘脑腹后外侧核/腹后内侧核( VPL/VPM)脑深部电刺激(DBS)联合导水管周围灰质/脑室旁下丘脑核团(PAG/PVG) DBS治疗神经性疼痛的疗效.方法对24例神经性疼痛患者进行回顾性分析,除早期2例只使用PVG作为靶点外,其他患者均采用VPL/VPM联合PAG/PVG DBS进行治疗,并在术前、术后3个月采用视觉模拟评分(VAS)评估疼痛级别,比较分析治疗效果.结果 22例成功接受VPL和PVG联合靶点治疗(其中5例为双侧),2例只接受单侧PVG- DBS.其中17例恢复良好(有效率70.8％),7例术后将DBS去除(1例颅内感染,6例疗效较差).所有患者术前VAS评分平均为(8.04±0.86)分,术后VAS评分平均为(3.13±1.44)分,P＜0.05.有效患者中VPL靶点的疗效均满意,PVG靶点的有效例数为12例.7例PVG靶点产生明显不良反应,VPL靶点无明显不良反应.结论利用PVG/VPL联合治疗慢性神经痛有一定的疗效,但由于PVG的疗效不甚满意及不良反应较多,VPL也许更适合作为神经性疼痛治疗的靶点.
목적 탐토구뇌복후외측핵/복후내측핵( VPL/VPM)뇌심부전자격(DBS)연합도수관주위회질/뇌실방하구뇌핵단(PAG/PVG) DBS치료신경성동통적료효.방법 대24례신경성동통환자진행회고성분석,제조기2례지사용PVG작위파점외,기타환자균채용VPL/VPM연합PAG/PVG DBS진행치료,병재술전、술후3개월채용시각모의평분(VAS)평고동통급별,비교분석치료효과.결과 22례성공접수VPL화PVG연합파점치료(기중5례위쌍측),2례지접수단측PVG- DBS.기중17례회복량호(유효솔70.8％),7례술후장DBS거제(1례로내감염,6례료효교차).소유환자술전VAS평분평균위(8.04±0.86)분,술후VAS평분평균위(3.13±1.44)분,P＜0.05.유효환자중VPL파점적료효균만의,PVG파점적유효례수위12례.7례PVG파점산생명현불량반응,VPL파점무명현불량반응.결론 이용PVG/VPL연합치료만성신경통유일정적료효,단유우PVG적료효불심만의급불량반응교다,VPL야허경괄합작위신경성동통치료적파점.
Objective To discuss the treatment of neuropathic pain with ventral posteromedial thalamic nucleus/ventral posterolateral thalamic nucleus (VPL/VPM) DBS combined periventricular/ periaqueductal grey matter (PAG/PVG) DBS. Methods A retrospective analysis of 24 patients with neuropathic pain was performed. At the early time,two patients just accepted PVG - DBS.The other patients were treated by VPL/VPM DBS combined PAG/PVG DBS.The effects of stimulation were studied right after electrode insertion or the stimulation trials was done after 5 - 7days after surgery.Patients with a greater than 50％ reduction in pain visual analogue score (VAS) were implanted with a pulse generator (IPG).VAS was also recorded before operation and three months after the operation.Results All the patients tolerated the procedure very well.17 of them received good outcome.The instrument had to be removed in the other 7 patients because of infection ( n =1 ) or invalid efficacy ( n =6 ).The average VAS score before surgery was 8.04 ±0.86 and the average VAS score after surgery was 3.13 ± 1.44.There was significant difference.All effective patients had good outcomes when the VPL - DBS was on and 12 patients received good outcomes when the PVG - DBS was on.7 patients with PVG - DBS had severe side effects.There was no significant side effect in patients with VPL - DBS. Conclusions Many doctors prefer to combine VPL and PVG DBS to treat chronic neuropathic pain.But the efficacy and side effects of PVG target are not so satisfied.VPL DBS used alone may be accepted by more and more doctors.