老年病人脑深部电刺激术穿刺路径安全性研究

doi:10.3969/j.issn.1003-9198.2025.07.016

摘要/Abstract

摘要： 目的通过手术计划工作站模拟脑深部电刺激手术(DBS)穿刺,探讨老年PD病人在不同手术策略下行DBS的安全性。方法回顾性分析2014—2023年在南京医科大学第一附属医院院行DBS的≥65岁老年PD病人254例,调取病人影像导入手术计划工作站,每个病例均分别使用传统的手术穿刺策略(对照组)与个体化针道定制穿刺策略(定制组),以丘脑底核(STN)核团及苍白球外侧部(GPi)核团为靶点模拟手术穿刺,统计并比较2组穿刺针道途经脑部常见高风险解剖结构的发生率。结果 254例病人左右两侧均进行模拟手术穿刺,共508侧针道。以STN核团为穿刺靶点,定制组针道经过高风险解剖结构的比例远小于对照组(1.38%比28.94%,P<0.05);以GPi核团为穿刺靶点,定制组针道经过高风险解剖结构的比例远小于对照组(0.98%比25.20%,P<0.05)。结论使用手术计划系统模拟制定个体化穿刺路径相较于传统穿刺方法可大大降低穿刺到异常解剖结构的风险,减少穿刺部位出血并发症,提高手术的安全性。

关键词: 脑深部电刺激术, 帕金森病, 穿刺针道, 手术计划工作站

Abstract: Objective To study the safety of deep brain stimulation surgery (DBS) in the elderly patients with Parkinson’s disease receiving different surgical strategies by simulating the puncture of DBS through the operation planning workstation. Methods The clinical data of 254 elderly patients with Parkinson’s disease aged ≥65 years who underwent DBS in the First Affiliated Hospital of Nanjing Medical University from 2014 to 2023 were retrospectively analyzed. The images of the patients were transfered to the operation planning workstation. Each case used the traditional surgical puncture strategy (control group) and the customized puncture strategy (customized group) respectively to simulate the surgical puncture with the subthalamic nucleus (STN) and the lateral part of the globus pallidus (GPI) as the targets. The incidence of puncture needle path through the common high-risk anatomical structures in the brain was recorded and compared between the two groups. Results A total of 254 patients underwent simulated surgical puncture on both sides, with a total of 508 needle paths. With the STN nucleus as the puncture target, the proportion of the needle path passing through the high-risk anatomical structure in the customized group was much less than that in the control group (1.38% vs 28.94%, P<0.05); When the GPI nucleus was used as the target for puncture, the proportion of the needle path passing through the high-risk anatomical structure in the customized group was much less than that in the control group (0.98% vs 25.20%, P<0.05). Conclusions Using the operation planning system to formulate the individualized puncture path can greatly reduce the risk of puncture to the abnormal anatomical structure, reduce the bleeding complications at the puncture site, and improve the safety of the operation.

Key words: deep brain stimulation, Parkinson’s disease, puncture needle path, surgical planning system

中图分类号:

R742

鄂语乾, 曹纹平, 赵春生, 曹胜武. 老年病人脑深部电刺激术穿刺路径安全性研究[J]. 实用老年医学, 2025, 39(7): 727-731.

E Yuqian, CAO Wenping, ZHAO Chunsheng, CAO Shengwu. Study on the safety of trajectory for deep brain stimulation in elderly patients[J]. Practical Geriatrics, 2025, 39(7): 727-731.

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