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Source: People's Daily Health Client Clicks: 359 times Release time: November 14, 2024 Author: Zhang Shuang

(People's Daily Health Client reporter Zhang Shuang) "The morning after the operation, I opened the door of the ward and my mother called out my name. At that moment, I felt that my mother was finally back."

This scene, for many Alzheimer's family members, is like a dream scene. Now through surgery, it may really become a reality.

Ningbo Second Hospital of Zhejiang Province announced on November 8 that the hospital performed deep neck lymphatic-venous anastomosis on a 76-year-old man with moderate Alzheimer's disease, and the symptoms were significantly improved. The follow-up results 2 months after the operation showed that the elderly not only had a significant recovery in memory, but also could communicate normally with people.

People's Daily Health Client reporter noted that since this year, many three domestic Hospital A has carried out similar operations. Does this mean that there is a way to "reverse" Alzheimer's disease?

On September 14, the team led by Guo Zonghui, deputy director of the Department of Microsurgery at Ningbo Second Hospital, performed deep neck lymphatic-venous anastomosis on Aunt Li. Photo from Ningbo Second Hospital

The operation is like a "dredge", clearing away the pathogenic proteins in the brain

"The theoretical basis of deep neck lymphatic-venous anastomosis is the abnormal accumulation of Aβ-amyloid protein in the brain and abnormal phosphorylation of tau protein, which are two important causes of Alzheimer's disease." On November 11, Guo Zonghui, deputy director (in charge) of the Department of Microsurgery and Repair at Ningbo Second Hospital, who performed the operation, told the reporter of the People's Daily Health Client that the operation uses super microsurgery technology to shunt the lymphatic circulation in the meninges, speed up the return of intracerebral lymph through the jugular foramen at the base of the skull, and take away more metabolites in the brain, thereby achieving the goal of possibly reversing brain degenerative lesions and slowing down the progression of the disease.

"It can be simply understood as a mechanical excretion process. "Guo Zonghui said that the abnormal accumulation of amyloid protein in the brain of the elderly is like a clogged sewer, and the "waste" cannot be transported out in time. The deep neck lymphatic-venous anastomosis can greatly speed up the removal of "waste" and improve the removal efficiency.

On the morning of November 11, Professor Tang Juyu, director of the Clinical Research Center for Microsurgery Reconstruction at Xiangya Hospital of Central South University, had just completed the 42nd deep neck lymphatic-venous anastomosis in the hospital. Because it is a minimally invasive surgery, the patient can get out of bed and move around the next day. Among these 42 patients, in addition to restoring memory, Tang Juyu also saw that the patients who were originally indifferent and taciturn could communicate with him in a laughing manner during the postoperative follow-up.

On March 12, the team of Professor Tang Juyu, director of the Clinical Research Center for Microsurgery Reconstruction at Xiangya Hospital of Central South University, checked the patient's recovery. Xiangya Hospital of Central South University Figure

The immediate effect does not represent the final effect, and large-scale clinical trials are still needed

Although many patients have obvious symptom improvement after surgery, the above experts also believe that this surgery can only provide a new idea for the current treatment of Alzheimer's disease, and the specific effectiveness still needs more research to confirm.

Gao Ping, chief physician of the Department of Neurology at Beijing Hospital, told the reporter of the People's Daily Health Client that there is currently no specific treatment for Alzheimer's disease, and the latest monoclonal antibody drugs with disease-modifying treatment (such as Lencanermab (Leyibao) that has been launched in my country) can only delay the progression of the disease to a certain extent. "Because the pathogenesis of the disease has not been thoroughly understood. Although there are many hypotheses and mechanisms involved, there is currently no single hypothesis that can perfectly explain the occurrence and development of the disease. Therefore, the existing drugs or treatments developed for a single mechanism cannot reverse the progression of the disease, let alone completely solve or cure Alzheimer's disease. ”

“For Alzheimer’s disease, we cannot judge the effect of surgery only from the immediate improvement of the patient’s symptoms after surgery. The patient needs to undergo multiple tests at different time points after surgery, including neurological evaluation, imaging examination, cerebrospinal fluid examination, etc., in order to finally determine the result.” Tang Juyu told reporters.

Guo Zonghui also said that, for example, the patient Aunt Li mentioned above still needs to cooperate with comprehensive treatments such as drugs, physical therapy, rehabilitation, etc. after surgery to continue to control the disease and conduct long-term follow-up. “Surgery can only achieve the effect of clearing the abnormal accumulation of amyloid protein in the brain, but it cannot guarantee that new accumulation will not form in the future. ”

“Generally speaking, this method is just an attempt and exploration. Its efficacy and safety still need to be verified by large-scale clinical trials. The current surgical results of individual cases cannot fully explain whether the surgery itself is universal. "Gao Ping summarized to the reporter.

Not all patients can do it, they need to meet the corresponding indications

Among the 42 patients who have undergone this operation at Xiangya Hospital of Central South University, most of them have MMSE scores below 9 points, are in severe cognitive impairment, and can no longer control the disease through drugs. However, for advanced patients, the necrosis of nerve cells in the brain cannot be reversed, which also poses a challenge to the final surgical effect of deep cervical lymphatic-venous anastomosis.

"In addition, even if the patient's family members have a strong desire for surgery, they need to have surgical indications before the operation can be performed." Tang Juyu specifically pointed out that first, it needs to be confirmed by a neurology specialist; secondly, the patient's Aß-PET and Tau-PET imaging diagnoses must be positive; finally, the patient must undergo a surgical tolerance assessment. If the patient suffers from certain serious underlying diseases, he may not be suitable for this operation.