立体定向双侧内囊前肢毁损术治疗难治性抑郁症  

Stereotactic bilateral anterior internal capsulotomy for refractory depression disorders

作　　者：田帅伟 潘宜新[1] 林国珍[2] 李永超[3] 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,上海200025 [2]上海交通大学医学院附属瑞金医院心理科,上海200025 [3]上海市杨浦区精神卫生中心,200090

出　　处：《中华神经医学杂志》2015年第2期116-118,共3页Chinese Journal of Neuromedicine

摘　　要：目的 评估立体定向双侧内囊前肢毁损术治疗难治性抑郁症的疗效及并发症情况。方法 收集上海瑞金医院功能神经外科自2008年3月至2012年12月应用立体定向双侧内囊前肢毁损术治疗的21例抑郁症患者临床资料,术前及术后1年应用汉密尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）、简易精神状态检查量表（MMSE）对患者精神状态进行评估及比较,以评价治疗效果。 结果 （1）抑郁症患者术后HAMD、HAMA量表评分与术前差异有统计学意义（P＜0.05）,MMSE评分差异无统计学意义（P＞0.05）。（2）术后1年,临床控制6例,显著改善8例,进步5例,无效2例,总体有效率90.5％（19/21）。（3）并发症：3例患者出现轻度认知障碍短暂记忆障碍,均于1周内消失;3例患者术后有情感淡漠,懒散;2例患者术后出现体质量增加,所有患者均无颅内出血、神经损伤等严重并发症。 结论 立体定向双侧内囊前肢毁损术有确切的疗效,对于难治性抑郁症可作为一种补充治疗手段。Objective To investigate the effect ofstereotactic bilateral internal capsulotomy on patients with refractory depression disorders and thier complications.Methods Twenty-one patients with treatment-resistant depression,admitted to and underwent stereotactic bilateral internal capsulotomy in our hospital from March 2008 to December 2012,were chosen.Their clinical data were retrospectively analyzed; before and one year after operation,Hamilton depression rating scale （HAMD）,Hamilton anxiety rating scale （HAMA） and mini-mental state examination （MMSE） were performed by psychiatrist to evaluate the treatment efficacy.Results （1） The total scores of HAMA and HAMD after operation were significantly lower than those before operation （P〈0.05）,while no obvious difference in the MMSE scores was noted between before and after operation.（2） One year after the operation,6 patients met the criterion of clinical control,8 improved significantly,5 got improvement and 2 did not improve; the total effective rate was 90.5% （19/21）.（3） Complications included mild cognitive deficit and transient dysmnesia in 3 patients who all recovered in one week,absence of interest as well as inactiveness in 3 patients,and weight-gain in 2.No serious complications such as cerebral hemorrhage and nerve injuries were noted in all the patients after the operation.Conclusion Stereotactic bilateral capsulotomy is an effective treatment method which can be considered as a compensatory way of treating refractory depression disorders.

关 键 词：立体定向技术 难治性抑郁症 内囊前肢毁损术 

分 类 号：R749.4[医药卫生—神经病学与精神病学]