摘要：

目的 探讨脑深部电刺激术治疗帕金森病的长期安全性，以规范操作步骤。方法 采用脑深部电刺激术治疗362 例帕金森病患者，共植入613 根电极，记录围手术期和最后一次随访时手术相关和硬件相关并发症。结果 围手术期并发症中术后嗜睡和谵妄21 例（5.80%），颅内出血4 例（1.10%，2 例为无症状性皮质少量出血、2 例为基底节穿刺针道周围少量出血），全面性强直-阵挛发作2 例（0.55%），尿路感染4例（1.10%），呼吸系统感染7例（1.93%），胸部脉冲发生器囊袋内血肿11例（3.04%），脉冲发生器囊袋内血清肿3 例（0.83%），均经治疗后痊愈出院。术后随访12 ~ 146 个月，中位值34 个月，硬件相关并发症中切口感染和（或）皮肤破溃9 例（2.49%），脉冲发生器移位致延长线断裂、脉冲发生器固定线断裂致下移至腹部、因摔倒致电极轻度移位、自觉耳后切口肿胀不适各1 例（0.28%）。结论 脑深部电刺激术治疗帕金森病长期安全性良好。

关键词: 帕金森病, 深部脑刺激法, 随访研究

Abstract:

Objective To evaluate the safety of deep brain stimulation (DBS) for treating Parkinson's disease (PD) under long-term follow-up and modify the surgical procedure. Methods A total of 362 PD patients underwent DBS, and almost 613 electrodes were implanted into these patients. Both surgical and hardware-related complications of DBS were retrospectively analyzed. Results Perioperative complications included postoperative confusion or delirium in 21 cases (5.80%), intracranial hemorrhage in 4 cases (1.10%; 2 asymptomatic cortical microhemorrhage and 2 basal ganglia trajectory microhemorrhage), generalized tonic-clonic seizures (GTCS) in 2 cases (0.55% ), urinary tract infection in 4 cases (1.10% ), pulmonary infection in 7 cases (1.93%), implantable pulse generator (IPG) hematoma in 11 cases (3.04%), IPG seroma in 3 cases (0.83%). All these patients were cured. They were followed-up for 12-146 months (median 34 months). Hardware-related complications included infection of incisional wound and/or skin erosion (9 cases, 2.49% ), extension wire fracture caused by IPG displacement (one case, 0.28% ), IPG shifting to abdomen due to fixation wire fracture (one case, 0.28%), slightly migrated electrode due to fall (one case, 0.28%), and discomfort about occipital incision (one case, 0.28%). Conclusions The overall risk of both surgical and hardware-related adverse events of DBS for treating PD is acceptably low.

Key words: Parkinson disease, Deep brain stimulation, Follow-up studies