立体定向双侧内囊前肢毁损治疗难治性强迫症（五年随访研究）  

5 years follow up of the clinical effect of bilateral capsulotomy in patients with refractory obsessivecompulsive disorde

作　　者：许大远[1] 占世坤[1] 李殿友[1] 李永超 潘桂花[3] 潘宜新[1] 李锋[1] 孙伯民[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院功能神经外科,200025 [2]上海杨浦精神卫生中心 [3]上海市精神卫生中心

出　　处：《中华神经外科杂志》2009年第5期446-448,共3页Chinese Journal of Neurosurgery

摘　　要：目的探讨内囊前肢毁损治疗难治性强迫症的长期临床疗效及不良反应。方法对32例难治性强迫症病人，采用MRI导向立体定向双侧内囊前肢毁损治疗。术前及术后5年对患者进行相关量表的评测。结果32例手术病人中19例强迫症状完全消失，8例明显改善，3例稍有改善，2例无明显变化。3例患者出现意志减弱，其中1例经过系统心理治疗后恢复；2例病人术后出现轻度情感和行为幼稚。结论MRI导向立体定向双侧内囊前肢毁损术定位精确、安全、显效迅速，对难治性强迫症患者有明显而稳定的疗效，并可提高患者的生活质量，恢复社会功能。Objective To study the clinical effect and complications of bilateral capsulotomy in patients with refractory obsessive-compulsive disorders. Method 32 cases with refractory obsessive- compulsive disorder underwent MRI guided stereotactic bilateral anterior capsulotomy. Pre-operative and 5 years post-operative psychiatric rating scales were evaluated. Results In all of 32 cases, 19 cases had OCD symptoms free,8 cases had significant improvement, 3 cases had partial improvement and 2 cases had no improvement. 3 cases experienced hypobulia and one of them recovered after systematic psychological and behavior therapy. 2 cases showed emotional and behaviour infantility. Conclusions MRI guided stereotactic bilateral capulotomy is a precise, safe, promising therapy for refractory. It also improves the quality of life of patients and restore social function.

关 键 词：强迫性人格障碍 精神外科手术 内囊前肢毁损术 放射外科手术 

分 类 号：R686[医药卫生—骨科学]