Chen P, Xiong C, Jiang M L, Zhuang H X, Mei J M, Niu C S
Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Anhui Provincial Key Laboratory of Brain Function and Disease, Hefei 230001, China.
Department of Neuroelectrophysiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230036, China.
Zhonghua Yi Xue Za Zhi. 2023 Dec 19;103(47):3822-3827. doi: 10.3760/cma.j.cn112137-20231030-00945.
To analyze the complications related to deep brain stimulation(DBS) surgery in Parkinson's disease(PD) patients and to determine whether there is a learning curve effect in terms of complications. Retrospective analysis of the DBS surgical data of 822 PD patients performed by the same surgeon at the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from December 2012 to December 2022. The complications related to DBS were evaluated and analyzed the complications of every 100 DBS surgery were further analyzed. A total of 822 PD patients, 453 males and 369 females, aged 31-80 years old, were included. The minimum follow-up period after DBS surgery is 6 months. Surgical related complications occurred in 55 patients (6.69%), including 5 patients (0.61%) with slight bleeding around the electrode, 1 patient (0.12%) with cerebral infarction, 4 patients (0.49%) with postoperative epilepsy, 42 patients (5.11%) with postoperative delirium, 2 patients (0.24%) with respiratory distress, and 1 patient (0.12%) with acute cardiac insufficiency. There were 16 cases (1.94%) of hardware related complications in DBS, of which 4 cases (0.48%) had infection, 1 case (0.12%) had a broken angle at the connection between the pulse generator and the extension wire, 8 cases (0.97%) had an excessively tight extension wire, and 3 cases (0.36%) had an IPG bag hematoma. In the infected cases, 2 patients removed IPG and extension wires. There were 7 cases (0.85%) of stimulus related complications, including 4 cases (0.61%) with programmed sensory abnormalities, 1 case (0.12%) with postoperative abnormal movements and dance like movements, and 2 cases (0.24%) with psychiatric symptoms. A comprehensive analysis was conducted on the above complications, among which 8 cases (0.97%) were relatively serious complications. After active treatment, satisfactory results were achieved, and none of them affected the patient's DBS treatment effect and no patients died. For every 100 cases of DBS surgery complications were analyzed, the percentage of complications decreased significantly from 14.50% (58 cases) in the first 400 cases to 4.73% (20 cases) in the last 400 cases (<0.001). DBS surgery is safe and has an acceptable low incidence of complications. The incidence of complications also decreases with the accumulation of experience, showing a learning curve effect.
分析帕金森病(PD)患者深部脑刺激(DBS)手术相关并发症,并确定并发症方面是否存在学习曲线效应。回顾性分析2012年12月至2022年12月在中国科学技术大学附属第一医院(安徽省立医院)由同一位外科医生为822例PD患者进行的DBS手术数据。评估与DBS相关的并发症,并进一步分析每100例DBS手术的并发症情况。共纳入822例PD患者,其中男性453例,女性369例,年龄31 - 80岁。DBS手术后最短随访期为6个月。手术相关并发症发生在55例患者中(6.69%),包括电极周围轻微出血5例(0.61%)、脑梗死1例(0.12%)、术后癫痫4例(0.49%)、术后谵妄42例(5.11%)、呼吸窘迫2例(0.24%)、急性心功能不全1例(0.12%)。DBS硬件相关并发症有16例(1.94%),其中感染4例(0.48%)、脉冲发生器与延长线连接处角度折断1例(0.12%)、延长线过紧8例(0.97%)、IPG袋血肿3例(0.36%)。在感染病例中,2例患者移除了IPG和延长线。刺激相关并发症有7例(0.85%),包括程控感觉异常4例(0.61%)、术后异常运动和舞蹈样动作1例(0.12%)、精神症状2例(0.24%)。对上述并发症进行综合分析,其中8例(0.97%)为相对严重的并发症。经过积极治疗,取得了满意的效果,均未影响患者的DBS治疗效果,也无患者死亡。对每100例DBS手术并发症进行分析,并发症发生率从前400例的14.50%(58例)显著降至后400例的4.73%(20例)(<0.001)。DBS手术是安全的,并发症发生率较低且可接受。并发症发生率也随着经验积累而降低,呈现学习曲线效应。