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目的 确定各类帕金森病的定向手术适应证。方法 回顾分析 1478例帕金森病定向手术 ,对手术后的手术疗效和某些相关并发症进行评估 ,进而推断各类帕金森病的定向手术适应证。结果 苍白球毁损术对服用左旋多巴类药物有效的震颤患者均有效 ,服用左旋多巴类药物震颤无效的患者 ,苍白球毁损术的手术疗效效果很差 ,单侧丘脑Vim核毁损术对震颤改善极佳 ,96 9%的患者彻底消失 ,同期同侧苍白球 +丘脑Vim核毁损术的患者震颤改善率为 96 3% ,苍白球毁损术对僵直、运动迟缓的疗效也显示出与左旋多巴服药反应的规律性 ,服药效果好的手术效果较好 ,但是 ,与震颤不同的是 ,服药无效的也有一定的疗效。启动不能患者 ,其手术效果都不佳 ,流涎、吞咽困难发生率在单侧苍白球毁损术患者中较低 ,乏力发生率较高 ,分期双侧苍白球毁损术中患者年龄较大的较易发生乏力、流涎、吞咽困难。结论 我们的临床实践认为左旋多巴类药物服药反应是一个非常重要的判定指标 ,僵直、运动迟缓、药物引起的“开 关”、异动症服药有效的患者 ,苍白球毁损术的效果较好 ;震颤则有所不同 ,凡是左旋多巴不能完全控制的 ,采用苍白球 +丘脑Vim核毁损术则手术效果非常满意 ,启动不能的患者手术应该极其慎重 ,手术的帮助不大。我们不主张同期双侧
Objective To determine the indications for all types of Parkinson’s disease. Methods A retrospective analysis of 1478 patients with Parkinson’s disease directed surgery, the surgical effect of surgery and some related complications were evaluated, and then to determine the indications of various types of Parkinson’s disease directed surgery. Results The pallidotomy was effective in tremor patients taking levodopa drugs. Patients taking levodopa-based drugs with tremor were ineffective in the treatment of globus pallidus. Vim nucleus unilateral thalamus injury to tremor The improvement was excellent, 96.9% of patients completely disappeared, the same period ipsilateral globus pallidus + thalamus Vim nuclear damage in patients with tremor improvement rate of 96 3%, globus pallidus surgery on stiffness, slow motion effect also showed more with L-more Pakistan take the regularity of medication response, good medication effect of surgery is better, but unlike tremor, medication ineffective also has some effect. Start patients who can not, their surgical results are poor, salivation, dysphagia incidence in patients with unilateral globus pallidus lower, the higher the incidence of fatigue, patients with staging bilateral globus pallidus tend to be older Fatigue, salivation, difficulty swallowing. Conclusions Our clinical practice suggests that the response to levodopa drugs is a very important criterion for determining the effect of globus pallidus in patients with stiffness and movement retardation, drug-induced “switch-on” and effective treatment of dyskinesias; tremor Is different, any levodopa can not be completely controlled, the use of globus pallidus + thalamus Vim nuclear damage surgery results are very satisfied, the patient can not start surgery should be extremely cautious, the operation is not helpful. We do not advocate contemporaneous bilateral