Li Y, Shi C, Shao M, Ding Y
Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Beijing 100053, China.
Zhonghua Wai Ke Za Zhi. 2000 Mar;38(3):165-8.
To clarify the benefits and risks of patients undergoing bilateral posteroventral pallidotomy (BPVP) for patients with idiopathic Parkinson's disease (PD) and the differences between contemporaneous BPVP (CBPVP) and staged BPVP (SBPVP).
Twenty patients underwent microelectrode-guided CBPVP and 26 SBPVP for bilateral PD symptoms. The data were retrospectively reviewed. Unified Parkinson's Disease Rating Scale (UPDRS) was used to evaluate the effects of these operations.
BPVP, either CBPVP or SBPVP, significantly improved patients' bilateral PD symptoms (P < 0.001). The improvement was consistently higher in "off" state than in "on" state. No statistical difference was observed in the improvement percentages of CBPVP, SBPVP1 and SBPVP2. CBPVP contributed greatly to L-dopa induced side effects (part IV). BPVP, SBPVP1, and SBPVP2 significantly improved cardinal parkinsonian signs but no difference was found among them. One patient after CBPVP developed hypophonia and swallowing problem, while 2 patients after SBPVP sustained hypophonia. These conditions were improved 3 months later.
BPVP may significantly improve bilateral signs of PD. It is safer than bilateral thalamotomy. CBPVP is applicable to some patients. BPVP may not cause mental impairment but shows a higher incidence rate of hypophonia. The practice of BPVP requires a refined surgical technique and a better understanding of pathophysiology of the basal ganglia.
阐明特发性帕金森病（PD）患者接受双侧苍白球腹后内侧切开术（BPVP）的获益与风险，以及同期双侧苍白球腹后内侧切开术（CBPVP）与分期双侧苍白球腹后内侧切开术（SBPVP）之间的差异。
20例患者接受了微电极引导下的CBPVP，26例患者接受了SBPVP以治疗双侧PD症状。对数据进行回顾性分析。采用统一帕金森病评定量表（UPDRS）评估这些手术的效果。
BPVP，无论是CBPVP还是SBPVP，均能显著改善患者的双侧PD症状（P<0.001）。“关”期的改善始终高于“开”期。CBPVP、SBPVP1和SBPVP2的改善百分比未见统计学差异。CBPVP对左旋多巴诱发的副作用（第四部分）有很大影响。BPVP、SBPVP1和SBPVP2均能显著改善帕金森病的主要体征，但它们之间未发现差异。1例CBPVP术后患者出现声音嘶哑和吞咽问题，而2例SBPVP术后患者持续存在声音嘶哑。这些情况在3个月后有所改善。
BPVP可显著改善PD的双侧体征。它比双侧丘脑切开术更安全。CBPVP适用于部分患者。BPVP可能不会导致精神障碍，但声音嘶哑的发生率较高。BPVP的实施需要精湛的手术技术和对基底节病理生理学的更好理解。
