精神发育迟滞伴严重行为障碍的立体定向外科治疗  

Mental retardation combined with severe behavior disorders: stereotactic surgical management

作　　者：刘爱军[1] 李安民[2] 张海涛[1] 柴旭斌[1] 张志文[1] 杜春晖[1] 

机构地区：[1]解放军总医院第一附属医院神经外科,北京100048 [2]解放军总医院海南分院神经外科,海南三亚572013

出　　处：《中华神经外科疾病研究杂志》2014年第2期156-158,共3页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的总结32例脑立体定向双侧杏仁核毁损和扣带回前部切开术治疗精神发育迟滞伴严重行为障碍的临床疗效。方法所有患者均明确诊断为精神发育迟滞伴严重行为障碍,经3年以上的药物治疗无效。术前患者精神发育迟滞程度经韦氏智力测试评估分级,临床症状严重程度经临床大体评定量表(GAS)评估。手术采用脑立体定向,磁共振定位后,双侧杏仁核毁损、扣带回前部切开。手术后随访时间不少于24个月,再次进行病情严重程度评估。结果患者术后经磁共振复查,手术靶点准确无误。手术后的GAS平均分对比手术前有明显提高,患者总体生活质量改善。精神发育迟滞程度在轻度的患者,手术疗效优于中度和重度的精神发育迟滞患者。本组患者未出现严重手术并发症。结论脑立体定向双侧杏仁核毁损联合扣带回前部切开术对于控制轻度精神发育迟滞患者的行为障碍效果较好,生活质量改善明显。Objective The study aims to investigate the bilateral amygdalotomy and cingulotomy for mental retardated patients with severe behavior disorders.Methods All of these patients enrolled in this study were diagnosed as mental retardation with severe behavior disorders and resistant to medical treatment.Preoperatively,the scale of mental retardation was evaluated by intelligent quota score,and clinical severity was evaluated by Global Assessment Scale （GAS）.Bilateral amygdalotomy and cingulotomy were performed under the guidance of MRI stereotactically.The duration of postoperative follow-up was not less than 24 months,and the clinical severity was re-evaluated by GAS.Results After surgery,MRI of these patients confirmed the accuracy of the lesion targets.Compared with preoperative score,the postoperative score of GAS was increased significantly （18.9±5.5 vs 29.5 ± 9.9）,indicating improved life quality in most of these patients.The surgical results in patients with mild mental retardation were better than that of patients with moderate and severe mental retardation.No severe complication was found in these patients.Conclusion Bilateral amygdalotomy and cingulotomy can result in a decrease of behavior disorders and improve the life quality of the patients with mild mental retardation.

关 键 词：精神发育迟滞 行为障碍 脑立体定向术 

分 类 号：R749.93[医药卫生—神经病学与精神病学]