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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2020, Vol. 06 ›› Issue (06) : 350 -355. doi: 10.3877/cma.j.issn.2095-9141.2020.06.006

所属专题： 文献；

临床研究

全麻下单纯影像学引导的帕金森病丘脑底核脑深部电刺激手术的效果分析
党圆圆1, 夏小雨1, 杨艺2, 刘楠3, 单桐辉1, 杜少鹏1, 张志强1, 何江弘2,†()   
  1. 1. 100700　北京，解放军总医院第七医学中心神经外科
    2. 100070　北京，首都医科大学附属北京天坛医院神经外科
    3. 100700　北京，解放军总医院第七医学中心神经内科
  • 收稿日期:2020-07-24 出版日期:2020-12-15
  • 通信作者: 何江弘
  • 基金资助:
    国家自然科学基金(81771128)

Effect of asleep STN-DBS guided by image alone under general anesthesia in patients with Parkinson’s disease

Yuanyuan Dang1, Xiaoyu Xia1, Yi Yang2, Nan Liu3, Tonghui Shan1, Shaopeng Du1, Zhiqiang Zhang1, Jianghong He2,†()   

  1. 1. Department of Neurosurgery, the Seventh Medical Center, Chinese PLA General Hospital, Beijing 100700, China
    2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100700, China
    3. Department of Neurology, the Seventh Medical Center, Chinese PLA General Hospital, Beijing 100700, China
  • Received:2020-07-24 Published:2020-12-15
  • Corresponding author: Jianghong He
  • About author:
    Corresponding author: He Jianghong, Email:
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引用本文：

党圆圆, 夏小雨, 杨艺, 刘楠, 单桐辉, 杜少鹏, 张志强, 何江弘. 全麻下单纯影像学引导的帕金森病丘脑底核脑深部电刺激手术的效果分析[J]. 中华神经创伤外科电子杂志, 2020, 06(06): 350-355.

Yuanyuan Dang, Xiaoyu Xia, Yi Yang, Nan Liu, Tonghui Shan, Shaopeng Du, Zhiqiang Zhang, Jianghong He. Effect of asleep STN-DBS guided by image alone under general anesthesia in patients with Parkinson’s disease[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(06): 350-355.

目的

分析单纯影像学引导的帕金森病（PD）丘脑底核脑深部电刺激（STN-DBS）的手术效果。

方法

回顾性分析解放军总医院第七医学中心神经外科自2017年6月至2019年1月行STN-DBS的原发性PD患者21例，按时间的先后顺序分为局麻组（前8例）和全麻组（后13例）。局麻组在局麻下植入电极，通过术中微电极记录及临床测试验证并矫正植入位置，全麻组在全麻下植入电极，通过术中CT扫描验证并矫正植入位置。比较2种手术流程靶点植入准确性、手术时间及术后疗效。

结果

全部患者均安全植入双侧电极并完成至少6个月术后随访。全麻组两侧电极的绝对误差均小于局麻组，差异有统计学意义（P<0.05）。2组两侧电极的径向误差差异无统计学意义（P>0.05）。全麻组手术时间明显少于局麻组，差异有统计学意义（P<0.05）。2组开机后6个月药物关期统一帕金森评分量表运动症状部分评分改善率、左旋多巴等效剂量下降值比较，差异均无统计学意义（P>0.05）。

结论

单纯影像学引导并使用术中CT验证电极位置的全麻STN-DBS手术与常规局麻手术相比用时更短，植入准确性及术后疗效同样满意。

关键词: 帕金森病, 丘脑底核, 脑深部电刺激, 麻醉
Objective

To analyze the accuracy of electrode placement and curative effect of subthalamic nucleus deep brain stimulation (STN-DBS) guided by image alone in patients with Parkinson’s disease (PD).

Methods

Twenty-one patients with PD who underwent STN-DBS from June 2017 to January 2019 in Neurosurgery Department of the Seventh Medical Center, Chinese PLA General Hospital were retrospectively analyzed. They were divided into local anesthesia group (first 8 cases) and general anesthesia group (last 13 cases). In the local anesthesia group, electrodes were implanted under local anesthesia, and the implantation position was verified and corrected by intraoperative microelectrode recording and clinical tests. In the general anesthesia group, electrodes were implanted under general anesthesia, and the implantation position was verified and corrected by intraoperative CT scanning. The accuracy of target implantation, operation time and postoperative efficacy were compared between the two procedures.

Results

All patients were safely implanted with bilateral electrodes and were followed up for at least 6 months after operation. The euclidean error of both electrodes in the general anesthesia group was less than that in the local anesthesia group, and the difference was statistically significant (P<0.05). There was no significant difference in radial error between 2 groups (P>0.05). The operation time in the general anesthesia group was significantly shorter than that in the local anesthesia group (P<0.05). There was no significant difference in the improvement rate of unified PD rating scale Ⅲ and the decrease value of levodopa equivalent daily dose between the two groups at 6 months after the drug was switched on (P>0.05).

Conclusion

The accuracy and effectiveness of image-guided and intraoperative CT-verified asleep STN-DBS surgery are comparable to that of awake procedure.

Key words: Parkinson disease, Subthalamic nucleus, Deep brain stimulation, Anesthesia
表1 全麻组和局麻组患者STN-DBS术前基线资料对比（±s）
项目 全麻组(n=13) 局麻组(n=8) t值 P值
年龄（岁） 58.54±8.27 65.63±9.35 1.816 0.085
病程（年） 10.69±5.51 8.00±2.73 1.279 0.216
UPDRS-Ⅲ（关期） 45.46±4.67 44.25±5.23 0.552 0.587
UPDRS-Ⅲ（开期） 19.00±3.16 18.25±5.01 0.423 0.677
LEDD(mg) 145.0±469.90 1125.0±311.7 1.728 0.100
HAMD（分） 14.08±3.75 11.63±4.31 1.376 0.185
ADL（分） 68.85±3.63 70.00±6.55 0.521 0.608
PDQ-8（分） 16.92±2.06 15.38±2.50 1.535 0.141
图1 术中CT与术前SWI融合像所示电极与靶点的关系
表2 全麻组和局麻组设计靶点坐标、路径角度及植入误差的对比（±s）
项目 左侧 t值 P值 右侧 t值 P值
全麻组(n=13) 局麻组(n=8) 全麻组(n=13) 局麻组(n=8)
坐标X(mm) 12.0±1.0 12.5±1.2 1.032 0.314 12.0±0.9 12.4±1.4 0.801 0.432
坐标Y(mm) 2.5±1.0 2.1±0.7 0.987 0.335 2.4±1.0 2.3±0.6 0.254 0.801
坐标Z(mm) 5.3±0.9 5.6±0.9 0.741 0.467 5.3±1.0 5.7±0.9 0.923 0.367
冠状面角度（°） 18.0±4.1 15.7±3.4 1.327 0.200 18.4±4.0 17.0±2.1 0.909 0.374
矢状面角度（°） 59.9±3.5 58.9±4.9 0.546 0.591 62.2±5.2 58.2±4.0 1.857 0.078
绝对误差(mm) 1.3±0.6 2.0±0.8 2.288 0.033 1.2±0.5 1.9±0.6 2.890 0.009
径向误差(mm) 0.6±0.4 0.4±0.5 1.012 0.323 0.4±0.1 0.5±0.4 0.871 0.394
表3 全麻组和局麻组手术时间及术后半年运动症状及服药改善率对比（±s）
项目 全麻组(n=13) 局麻组(n=8) t值 P值
手术时间(h) 4.08±0.35 4.82±0.96 2.550 0.020
开机后UPDRS-Ⅲ（药物关期） 21.08±3.95 19.75±5.20 0.663 0.515
UPDRS-Ⅲ改善率（药物关期，%） 53.54±7.81 55.78±8.29 0.623 0.541
LEDD下降差值(mg) 738.5±281.5 543.8±242.7 1.618 0.122
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