立体定向手术干预伏隔核治疗神经性厌食症  

Treatment of intractable anorexia nervosa with intervention of the nucleus accumbens using stereotactic surgery

作　　者：王景[1] 汪鑫[1] 荆江鹏 李嘉明[1] 李楠[1] 王学廉[1] 高国栋[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》2014年第6期321-326,共6页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的通过立体定向毁损术及脑深部电刺激能有效治疗神经性厌食症。方法共8例罹患神经性厌食症的患者通过立体定向手术干预伏隔核治疗神经性厌食症(其中6例患者接受双侧伏隔核毁损术,2例患者接受双侧伏隔核脑深部电刺激)。患者术前均接受正规的抗精神类药物及心理、营养治疗无效。患者术前及术后接受BMI指数、YBOCS,HAMA,HAMD量表的测定,评价疗效。结果 8例患者术后BMI指数均得到明显改善(P<0.01),除1名患者外,其余患者BMI指数均大于18.5kg/m2。接受双侧伏隔核毁损术的患者术后YBOCS,HAMA,HAMD指数均得到立即改善,接受双侧伏隔核脑深部电刺激的患者术后经过程控,各项评定也均得到有效控制。结论伏隔核是治疗神经性厌食症的有效靶点,立体定向手术干预伏隔核可有效改善神经性厌食症患者的各项症状。Objective This study investigates whether ablation of the nucleus accumbens（NAc）using stereotactic surgery can arouse the physiological drive to eat in intractable AN patients.Methods Eight patients with intractable AN were included;six patients underwent bilateral stereotactic radio frequency ablation in the NAc,two patients received bilateral NAc deep brain stimulation（DBS）implantation.Observations were made for basic vital signs,body mass index（BMI）,menstruation,depression,anxiety,obsessive-compulsion,personality,intelligence,memory,life quality,social function,as well as complications and adverse events associated with the treatment.Results Basic vital signs,BMI and menstruation had recovered one-year postoperation.Depression,anxiety and obsessive-compulsion were improved at one year postoperatively.There were changes in personality scores for psychoticism,neuroticism and lie tendencies that seemed to be helpful to the recovery of AN.Intelligence and memory improved after 6 months postoperatively.Life quality and social function were dramatically improved at 1year postoperatively.Conclusion The results of this study reveal that ablations of the NAc can increase the AN patients＇ physiological drive to eat.Furthermore,there were no severe and/or life-influencing complications associated with the treatment.

关 键 词：神经性厌食症 伏隔核 立体定向毁损术 脑深部电刺激 

分 类 号：R742.5[医药卫生—神经病学与精神病学]