改良颈动脉外膜交感神经切除术治疗以发作性痉挛为主要表现的抽动障碍
Modified cervical sympathectomy for treatment of tic disorders with paroxysmal spasm as the main manifestation
目的 探讨改良颈动脉外膜交感神经切除术治疗以发作性痉挛为主要表现的难治性抽动障碍的临床治疗效果.方法 回顾性纳入于2014年1月至2017年1月中日友好医院神经外科收治的20例以发作性痉挛为主要表现的难治性抽动障碍患者.所有患者均采用双侧改良颈动脉外膜交感神经切除术治疗.于术前、术后1个月、术后12个月采用国际通用的耶鲁综合抽动严重程度量表(YGTSS)对治疗效果进行评定.结果 20例患者随访时间为14~51个月,平均(25.10±10.25)个月.患者术后1个月、12个月的YGTSS评分中的运动性抽动评分[分别为(9.20±3.64)分、(9.25±3.67)分]和综合抽动严重程度评分[分别为(22.80±15.58)分、(21.65±16.17)分]与术前相比[分别为(19.00±1.17)分、(52.90±4.96)分]均明显降低,差异均有统计学意义(F值分别为68.13、35.62,均P<0.001).20例患者术后均无声音嘶哑、饮水呛咳等并发症发生.结论 改良颈动脉外膜交感神经切除术是治疗以发作性痉挛为主要表现的难治性抽动障碍患者的一种新的治疗选择,其短期随访安全、有效,而且并发症及不良反应较少.
更多Objective To evaluate the clinical effects of modified cervical sympathectomy for the treatment of tic disorders (TD) with paroxysmal spasm as the main manifestation and to analyze the feasibility of this method.Methods A total of 20 patients with TD,admitted to Department of Neurosurgery,ChinaJapan Friendship Hospital from January 2014 to January 2017,were enrolled into this study.All patients received cervical sympathectomy.The severities of TD symptoms were evaluated respectively by Yale Global Tic Severity Scale (YGTSS) in all patients before operation at 1 month and 12 months post operation.Results All patients were followed up for 14-51 months with an average of 25.10 ± 10.25 months.Twenty patients presented 1-month and 12-month postoperative motor tic severity scores of 9.20 ± 3.64 points and 9.25 ±3.67 points respectively.The 1-month and 12-month postoperative total YGTSS scores were 22.80 ± 15.58 points and 21.65 ± 16.17 points respectively.Compared with preoperative motor tic severity score (19.00 ± 1.17 points) and total YGTSS score (52.90 ± 4.96 points),the 1-month and 12-month postoperative scores showed significant difference (F =68.13,35.62,respectively,P < 0.001).No complications such as hoarseness,choking/coughing while drinking were observed in those 20 patients.Conclusion Modified cervical sympathectomy seems to be a feasible and effective method for the treatment of tic disorders with paroxysmal spasm as the main manifestation with relatively few complications or adverse reactions.
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