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)、McGill疼痛问卷(mcGill pain questionnaire,MPQ),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,MPQ,PPI,VRS评分手术前后差异显著(P<0.01)。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。
Objective To study the stereotactic neurosurgery lor the treatment of intractable central pain （CP）. Methods 6 patients with CP were employed clinically including 4 cases of thalamus or pontine infarction, one case of thalamus haemorrhage, another case of thalamus infarction and cervical cord injury. Bilateral nucleus accumbens and anterior cingulate gyrus lesion were co-performed in 6 patients. Statistical analyses were conducted using paired t test. Results The short-term （6 months） follow-up results showed a significant reduction in patient＇s pain scores （P〈0. 01）. The daily narcotic dosage of all patients decreased remarkably. There were no serious complication and surgery-related mortality. Conclusion Stereotactic neurosurgery procedure is effective and safe in relieving CP. The long-term （over 1 year） follow-up results need to further confirming.
出处
《立体定向和功能性神经外科杂志》
2009年第4期235-238,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
基金
清华大学裕元科学基金项目(编号:20240000534)
关键词
中枢神经痛
立体定向手术
伏核
扣带回
Central pain
Stereotactic neurosurgery
Nucleus accumbens
Cingulate gyrus
