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題 名 | Unilateral Stereotactic Posteroventral Globus Pallidus Internus Pallidotomy for Parkinson's Disease: Surgical Techniques and 2-Year Follow-up=單側立體定位蒼白球後腹側燒灼術治療帕金森氏症--手術方法及兩年追縱 |
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作 者 | 顏俊博; 吳曉臻; 蘇裕峯; 關皚麗; 洪純隆; 施邦英; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 21:1 民94.01 |
頁 次 | 頁1-8 |
分類號 | 415.83 |
關鍵詞 | 蒼白球; 巴金森氏症; 蒼白球切開術; 立體定位手術; Globus pallidus; Parkinson's disease; Pallidotomy; Stereotactic surgery; |
語 文 | 英文(English) |
中文摘要 | 自從一九六十年代末期左多巴氨被使用於治療帕金森氏症病患以來,它的顯著效果使得所有手術治療方法幾乎完全停頓。然而,近二十年來,手術治療帕金森氏症又再度興起,其主要原因乃是帕金森氏症病患經過長期左多巴氨治療後大多逐漸失去反應並出現嚴重的副作用。本研究包括九位帕金森氏症病患,其中男性三人,女性六人,平均年齡六十二歲,罹患帕金森氏症平均十三年,針對較嚴重肢體症狀之對側分別施以單側立體定位蒼白球燒灼術。病患分別在停藥及服藥後接受帕金森氏症評量表之評估,評估時間分別在手術前及術後第六、第十二及第二十四個月。針對評量表中停藥狀態下,日常生活和運動狀況的分數及總分在手術後兩年評估時,病患仍有顯著的進步,而這進步主要來自於對側運動遲緩及僵硬症狀的改善。至於在服藥狀態下,運動遲緩、僵硬及藥物引起的運動不能也顯示有意義的改善。基本上,身體軸及手術同側的症狀則無明顯的進步。手術引起的併發症並不顯著。一位病患在術後核磁共振檢查發現小出血,但臨床上並無症狀,另有兩位病人分別出現性慾過度及幻聽,但都在術後二週內消失。對於中、晚期的帕金森氏症病患,立體定位蒼白球燒灼術可以提供病患在運動症狀上相當程度的緩解,且效果可以持續兩年以上。對這些病患的進一步追蹤分析非常重要,尤其是確實的手術燒灼位置與相對的臨床症狀改善程度,因為這不但在臨床上讓手術醫師了解其手術的準確性,在基礎研究上也幫忙我們進一步了解帕金森氏症的生理病理機轉。 |
英文摘要 | With the advent of levodopa (L-dopa) and the recognition of its striking effect on Parkinson’s disease (PD), virtually all surgical procedures for PD ceased from the mid 1960s. However, there has been a resurgence of pallidotomy and other stereotactic procedures in the last two decades as physicians realized that most PD patients eventually face medical failure after long-term treatment with L-dopa. Nine PD patients, three men and six women, with an average age of 62 years and disease duration of 13 years underwent unilateral globus pallidus internus (Gpi) pallidotomy contralateral to the side with marked akinetic symptoms and drug-induced dyskinesia. All patients were evaluated using the Unified Parkinson’s disease Rating Scale (UPDRS) after drug withdrawal and while taking their optimal medical regimen, preoperatively and 6, 12, and 24 months after surgery. There was significant improvement in activities of daily living and motor subscores as well as total UPDRS score in the "off" state at the 2-year follow-up, which mainly resulted from improvement in contralateral bradykinesia and rigidity. Significant improvements in contralateral akinetic symptoms and drug-induced dyskinesia were also observed in the "on" state and were sustained for at least 2 years. Ipsilateral and axial symptoms were not altered by unilateral Gpi pallidotomy. The complications of surgery were generally well tolerated. One patient had a small postoperative asymptomatic hemorrhage identified by routine follow-up magnetic resonance imaging. Another two patients developed temporary sexual disinhibition and auditory hallucination, respectively, which resolved spontaneously 2 weeks after surgery. The effect of pallidotomy for alleviation of akinetic parkinsonism is modest but significant, and continues to be effective for at least 2 years. Further analytical studies, especially the correlation of clinical effects and lesion locations, are important not only to provide direct feedback for surgeons to examine the technical accuracy and but also to facilitate understanding of the pathophysiology of PD. |
本系統中英文摘要資訊取自各篇刊載內容。