立体定向伏隔核毁损术对酒精心理依赖疗效的初步研究  

Preliminary findings in ablating the nucleus accumbens using stereotactic surgery for alleviating psychological dependence on alcohol

作　　者：常崇旺[1] 吴鹤鸣[1] 葛顺楠[1] 孙继明[1] 耿宁[1] 王学廉[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710038

出　　处：《立体定向和功能性神经外科杂志》2011年第1期36-40,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的研究立体定向手术对酒精依赖患者的影响。方法12例有严重酒精心理依赖的患者（在不同康复中心接受了3～8次系统的脱酒治疗，但戒断两周后发生复饮）接受了立体定向双侧伏隔核毁损术的手术治疗。分别在术前和术后6个月对患者实施评估以分析该疗法的有效性和安全性。结果酒精戒断术后复饮率是：半年为16．7％（2／12），一年为25％（3／12）。12例患者中，1例发生了嗅觉障碍，但在术后4个月时恢复。与术前相比，患者的总智商和记忆商有显著的改善。这些患者酒精依赖严重程度量表和酒精渴求程度量表的评分均显著下降。患者的MMPI评分也显著下降，说明在抑郁、易怒性以及精神病理表现方面均有显著改善。结论本研究说明立体定向伏隔核毁损术是一项安全的并能缓解酒精心理依赖的的治疗方法，能够有效降低复饮率且提高患者术后的生活质量。Objective We studied the effect of stereotactic surgery in cases of alcohol dependence. Methods Twelve patients with a psychological dependence on alcohol （treated systematically with medication for detoxification 3-8 times in various rehabilitation centers before, but had relapsed within 2 weeks after withdrawal） were treated by ablating the nucleus accumbens （NAC） bilaterally using stereotactic surgery. The therapeutic effect and safety evaluation index of the surgery were analyzed. The timing of the conducted evaluations was preoperatively and in the sixth postoperative month. Currently, relapse has not occurred in 9 cases. Results Occurred in 3 cases after surgery. The prevalence of relapse was 16.7% within 6 months, and 25% within 12 months. Non-specific complications of this type of surgery （e. g. , intracranial hematoma, infection） were not observed. One case in 12 patients suffered dysosmia, but he recovered completely 4 months later after surgery. The full--scale intelligence quotient （FSIQ） and memory quotient （MQ） of these patients were significantly improved 6 months postoperatively compared with preoperatively. The severity of alcohol dependence scale and a scale measuring alcohol craving in these patients were significantly decreased. There were also significant changes over time in the Minnesota multiphasic personality inventory （MMPI） profile, suggesting a decrease in depression, irritability, and psychopathy. Conclusion Ablating specified targets （NAC） using stereotactic surgery is a safe method to alleviate alcohol craving, reduce relapse rates and improve quality--of--life in patients with psychological dependence on alcohol.

关 键 词：立体定向术 伏隔核 毁损 酒精依赖 疗效 

分 类 号：R749.62[医药卫生—神经病学与精神病学]