立体定向多靶点联合毁损术治疗情感障碍患者的疗效观察  

Therapeutic efficacy of multiple target and stereotactic operation on patients with affective disorder

作　　者：马久红[1] 柳婧美[2] 王学廉[1] 常崇旺[1] 王举磊[1] 薛伟宁[1] 赵巍[1] 高国栋[1] 

机构地区：[1]第四军医大学唐都医院脑功能疾病研究所,陕西西安710038 [2]第四军医大学西京医院消化病研究所,陕西西安710032

出　　处：《现代生物医学进展》2009年第2期295-297,共3页Progress in Modern Biomedicine

摘　　要：目的:研究立体定向多靶点联合毁损术在治疗以强迫症状为核心症状情感障碍患者中的疗效及并发症。方法:在立体定向基础上,应用3.0T高场强核磁共振、神经导航系统和微电极电生理技术进行核团定位,对37例以强迫症状为核心症状情感障碍患者行立体定向杏仁核、内囊前肢、扣带回、伏隔核多靶点联合毁损术。分别在术前2天与术后2周、6个月、1年由精神科医师进行Yale-Brown强迫症量表(Y-BOCS)、汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)测评,观察手术疗效及并发症。结果:37例患者中,3例痊愈,32例显效,2例复发,且痊愈和显效患者均发现术后抗情感障碍药物敏感性提高。术后随访期6～18个月,35例显著进步。术后6个月的总有效率94.5%,术后6个月、1年的总有效率与术后2周总有效率比较无明显差异,且无明显并发症。术后各期Y-BOCS、HAMD、HAMA评分与术前比较均明显降低。结论:立体定向杏仁核、内囊前肢、扣带回、伏隔核多靶点联合毁损术可以有效缓解患者强迫症状,提高药物敏感性,明显改善患者生存质量。Objective： To analyze the therapeutic effect and complications of affective disorder with compulsion in cure of multipie target and stereotactic operation. Methods： On the basis of the stereotactic, 37 patients who suffered affective disorder with compulsions were treated by stereotactic technique combined with 3.0 T Magnetic Resonance, Nervousness Navigation System and Electric Impedance Methods with bilateral amygdaloid nuclei, anterior limb of internal capsule, callosal gyrus, nucleus accumbens septi lesion by radio-frequency thermocoagulation. The therapeutic effects were estimated with Y- BOCS, HAMD and HAMA at the second week, sixth month and the first year after operation. Results： Among the 37 cases of patients, there were significant differences in measuring scale between preoperation and postoperation. Based on the code of decreased rate, 3 patients were cured, 32 patients were respectively improved and 2 patients were invalid. No complications and sequelae occurred. After operation the patients were more sensitive to anti-affective disorder drug. Following-up 6 to 18 months, there were 35 cases of significant progress. At the sixth month after operation, the effective power is 94.5 %. The total effective of six month and one year after operation was not significantly different with that of two weeks. Conclusions： The stereotactic technique with multiple locations was an effective method to treat affective disorder. It might be significant to relieve the compulsion, raise the sensitivity to anti-affective disorder drug and improve the quality of life.

关 键 词：强迫症状 情感障碍 立体定向 多靶点联合毁损术 

分 类 号：R749.4[医药卫生—神经病学与精神病学]