中文摘要：

目的分析帕金森病立体定向脑深部刺激术（DBS）和射频热凝毁损术中脑出血的危险因素，以降低脑出血并发症发生率。方法分别对626例帕金森病患者行DBS和射频热凝毁损术治疗，其中DBS108例，射频热凝毁损术507例，一侧DBS＋另一侧射频热凝毁损术11例。共手术治疗靶点774个，其中丘脑底核（STN）DBS术184个，丘脑腹中间核（Vim）DBS术1个，苍白球腹后部毁损术（PVP，行DBS或射频热凝毁损术）474个，Vim射频热凝毁损术115个。结果术后无症状性脑出血14例，症状性脑出血10例。有高血压病病史者的脑出血发生率为7．5％，显著高于无高血压病病史者的3．1％（x^2=4．77，P〈0．05）。微电极记录2～4条针道靶点的脑出血发生率为7．1％（12／170），显著高于微电极记录1条针道靶点的2．3％（10／443，x^2=8．19，P〈0．01）。PVP、Vim射频热凝毁损术的脑出血发生率均明显高于DBS（x^2=4．65、6．81，P值分别〈0．05、0．01）；Vim射频热凝毁损术的脑出血发生率略高于PVP，但差异无统计学意义（x^2=0．66，P〉0．05）。结论高血压病是帕金森病立体定向手术并发脑出血的危险因素。微电极记录针道数与脑出血发生率呈明显正相关，DBS是较射频热凝毁损术更安全的帕金森病外科治疗方法。

英文摘要：

Objective To analyze the risk factors of hemorrhage in patients with advanced Parkinson＇s disease receiving deep brain stimulation （DBS） and ablation procedure, so as to reduce the complications of hemorrhage. Methods We analyzed 626 patients with advanced Parkinson＇s disease who were treated by DBS and/or ablation procedure （DES in 108 cases, ablation in 507 cases and DBS after prior unilateral ablation procedure in 11 cases）. Of the 774 treatment targets, 184 received subthalamic nucleus （STN） DBS, 1 received ventral intermediate（Vim） DBS ,474 received pallidotomy （PVP）, and 115 received thalamotomy. Results There were 14 post-operation asymptomatic hematomas and 10 symptomatic hematomas. The incidence of hematom was 7.5% in patients with hypertension history and 3.1% in those without （P〈0.05）. The incidence of hematoma in 2-4 microelectrode recording penetrations was 7.1% （12/170）, which was significantly higher that in 1 microelectrode recording penetration （2.3%, P〈0.01）. The hemorrhage incidences of PVP and Vim were sig nificantly higher than that of DBS （P〈0.01 or 0.05）, and the incidence of Vim was slightly higher than that of PVP （P〈0.05）. Conclusion Hypertension and the number of microelectrode passes used to determine target location are risks of hemorrhage. Ablation procedure carries a higher risk of hemorrhage than DBS procedure.