伏隔核毁损术治疗药物依赖性脑病术后疗效随访分析  

Analysis of 1 year follow up results in patients who underwent bilateral nucleus accumbens ablation with stereotactic surgery for the treatment of drug dependence encephalopathy

作　　者：王学廉[1] 贺世明[1] 衡立君[1] 李维新[1] 梁秦川[1] 李江[1] 王举磊[1] 王家同[2] 高国栋[1] 

机构地区：[1]第四军医大学唐都医院神经外科,全军微创神经外科中心,第四军医大学功能性脑病研究所,西安710038 [2]第四军医大学航空航天医学系心理学教研室,全军心理测评中心

出　　处：《中华神经外科杂志》2005年第10期579-584,共6页Chinese Journal of Neurosurgery

基　　金：总后勤部卫生部临床高新技术重大项目(编号:200218);总后勤部卫生部全军医学科研"十五"计划资助项目(编号:04T402)

摘　　要：目的评价伏隔核定向毁损术戒毒的安全性和有效性。方法伏隔核定向毁损戒毒术后随访期达1年以上者42例,通过家庭访问、门诊、书信、电话,精神心理测评量表和随访调查问卷进行长期追踪随访,分析手术对一般生理学指标、本能行为、人格特征的影响及手术疗效、复吸率、并发症。对未复吸患者,不定期随机抽查尿检和纳络酮催瘾试验。结果除术后短期内出现中枢性高热外,手术对其他生理学指标无明显影响;对本能行为的影响主要表现为术后1个月性相关暗示刺激诱发动机降低,术后3个月恢复至正常水平。术后患者人格特征总体趋势无明显变化;短期内可出现注意力、近期记忆和睡眠障碍,于1周-1个月内自行恢复;对工作能力和远期记忆无影响;未复吸19例,复吸21例,失随访2例,术后1年期以上平均操守率45.2%,复吸率54.8%;影响手术疗效的因素:术前生理脱毒是否彻底,毁损灶大小,患者吸毒史长短、吸食毒品种类和所处社会环境;本组无死亡及感染病例。近期并发症:癫痫样发作1例(2.4%);远期并发症:动机形成障碍、对特征性刺激注意力下降、社会活动退避反应6例(14.3%),经康复训练3-6个月后症状减轻。结论伏隔核定向毁损术戒毒是安全、有效、可行的。手术的副反应和并发症发生率低,程度轻,是短暂的,可恢复的,与患者不能摆脱毒品折磨的痛苦相比,是在可接受范围内的。手术戒毒效果明显好于常规药物戒毒效果,是在常规药物戒毒无效的基础上,用于克服心理依赖,防止复吸的一种重要手段。Objective To study and evaluate safty and effectiveness of ablating nucleus accumbens bilaterally with stereotactic surgery for drug abstinence. Methods By family visiting,outpatient clinic, letters, telephone, answering and filling in psychological and investigating scales and questionnaires, a long term tracing follow up was made in 42 cases who had underwent bilateral nucleus accumbens ablation with stereotactic surgery for drug abstinence. Their postoperative follow up duration was longer than 1 year. Operation affected on general index, human being instinctive behavior, personality characteristic and efficacy, relapse rate, complication were analyzed. As to the cases who not relapsed after operation, drug urinalysis and naloxone test were made to confirm the results of follow up. Results Except central high fever during short period postoperation, no markedchange occurred on other physiological indexes. Compared with normal level, the sexual cue-induced motivation was reduced 1 month post operation （reduced 11 cases, 28.9%; mormal 27 cases, 71.7%） . 3 months post surgery, this function recovered to normal level （reduced 6 cases, 15.8%; normal 32 cases, 84.2%） . There was no obvious impact on personality characteristic in general. Attention decreasing, recent memory excalation and sleep disorder occurred in short period postoperation,but recovered within 1 week to 1 month. Work ability and long term memory was not affected. Relapse not occurred in 19 cases whereas occurred in 21 cases. 2 cases lost follow up. Average personal integrity rate over 1 year pestoperation was 45.2% whereas relapse rate was 54.8%. The factors involved in the therapeutic effect were complete detoxification, size of the site to be lesioned in nucleus accumbens, drug-taking history, kind of drugs involved and patients＇ social surroundings. There were no death and infection in these patients after operation. Complications in the near future were eleptiform fit in 1 case （2.4%） . Long term complications were motivation form

关 键 词：立体定向手术 戒毒 伏隔核 心理依赖 复吸 定向毁损术 术后疗效 随访分析 药物依赖性 手术疗效 

分 类 号：R651.1[医药卫生—外科学]