立体定向手术治疗顽固性中枢神经痛-清华大学玉泉医院神经调控中心.pdfVIP

立体定向和功能性神经外科杂志2009 年第22 卷第4 期　Chin J Stereotact Funct Neurosurg, Aug.2009, Vol.22, No.4 235 ·论 · 立体定向手术治疗顽固性中枢神经痛 王　林　陈国强　田　宏　王　岩　冯增伟　韩红彦　王晓松 　　[摘要] 　目的　研究脑立体定向手术治疗顽固性中枢神经痛(central pain, CP)的临床应用。方法　CP 患者6 例, 包括丘脑及脑桥梗塞4 例, 丘脑出血1例, 丘脑梗塞合并颈髓损伤 1例。所有病例均在局麻下行双侧扣带回及 双侧伏核(nucleus accumbens, NAc)毁损。手术前后采用视觉模拟评分(visual analog scale, VAS)、 cGill 疼痛问 卷(mcGill pain questionnaire, PQ), 口述描绘评分法(verbal rating scales, VRS)进行评分, 同时记录手术前后患 者使用镇痛剂的种类和最大剂量。将术后1周, 1 个月, 3 个月, 6 个月的评分和术前比较, 采用自身配对 t 检验。 结果　术后6 例患者从1周到6 个月止痛效果较好, 最长1例随访18 个月, 止痛效果稳定, 除1例丘脑出血后疼痛 患者目前偶尔口腹止痛片外, 其余患者到目前为止未用任何麻醉镇痛剂治疗。 VAS, PQ, PPI, VRS 评分手术前 后差异显 (P0.01)。结论　脑立体定向双侧伏核+双侧扣带回损毁手术治疗CP 具有较好的治疗效果, 超过1 年的长期疗效有待进一步观察。 [关键词] 　中枢神经痛;立体定向手术;伏核;扣带回 中图分类号:R338.3　　　文献标识码:A　　　文章编号:1008-2425(2009)04-0235-04 Stereotactic neurosurgery for intractable central pain 　　Wang Lin, Chen Guoqiang , Tian Hong , etal.Dep artmentof Neurosurgery , TheAf f iliated Yuquan Hosp italof Tsinghua Uni - versity , eij ing, 100049. [Abstract] 　Objective 　To study the stereotactic neurosurgery for the treatment of intracta- ble central pain (CP).Methods　6patients with CP were employed clinically including 4 cases of thalamus or pontine infarction, one case of thalamus haemorrhage, another case of thalamus in- farction and cervical cord injury.Bilateral nucleus accumbens and anterior cingulate gyrus lesion were co-performed in 6 patients.Statistical analyseswere conducted using paired t test.Results 　The short-term (6 months)follow-up results showed a significant reduction in patientspain scores (P0.01).The daily narcoticdosage of all patients decreased remarkably.Therewere no serious complication and surgery-related mortality.Conclusion　Stereotactic neurosurgery pro- cedure is effective and safe in relieving CP.The long-term (over 1 year)follow-up results need to further co