腹侧内囊前肢小毁损灶治疗难治性强迫症的随访观察  

Minimal ventral capsulotomy for refractory obsessive compulsive disorder:a nonrandomized clinical trial

作　　者：王滔[1] 张陈诚[1] 金海燕[2] 林国珍[2] 龚恒芬[3] 李永超[4] 于永沛[5] 占世坤[1] 孙伯民[1] 李殿友[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]上海交通大学医学院附属瑞金医院心理科,200025 [3]上海市浦东新区精神卫生中心,200122 [4]上海市杨浦区精神卫生中心,200093 [5]北京大学临床研究所,100191

出　　处：《中国微侵袭神经外科杂志》2016年第8期337-340,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金(编号:81271518;1471387);上海交通大学医学院-中科院神经所脑疾病临床研究中心

摘　　要：目的研究立体定向下双侧腹侧内囊前肢小毁损灶手术治疗难治性强迫症的临床疗效与安全性。方法 18例难治性强迫症病例,均行内囊前肢毁损术,毁损灶长度左侧内囊为10 mm,右侧内囊12 mm,术后1、3、6个月短期随访并以耶鲁-布朗强迫症状量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)评估症状改善情况及安全性指标。结果术后随访治疗有效11例(61.1%),部分有效1例(5.6%),无明显改善或无效6例(33.3%)。病人术后Y-BOCS评分显著降低,不良反应轻微。结论立体定向下双侧腹侧内囊前肢小毁损术对难治性强迫症有明显疗效,副作用多为短期、可恢复,是药物与心理治疗无效后的一种增效治疗选择。Objectives To investigate the efficacy and safety of a small ventral stereotactic lesioning to the bilateral anterior limb of the internal capsule for refractory obsessive compulsive disorder （OCD）. Methods Eighteen refractory OCD patients received ablative lesioning to the anterior limb of the internal capsule. The lesioned length was approximately 10 mm in the left and 12 mm in the right hemisphere. Postoperative follow-up was performed for 1, 3 and 6 months, and symptomatic improvement and safety indexes were assessed by psychiatrists using Yale-Brown Obsessive Compulsive Scale （Y-BOCS）, Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scales （HAM/））. Results The treament was effective in 11 （61.1%） patients, reported having partial response in 1 （5.6%）, no significant improvement or ineffective in 6 （33.3%）. There was a significant decrease in Y-BOCS score, and adverse reactions were mild. Conclusions Minimal lesions via ventral capsulotomy for OCD exhibit apparent efficacy and adverse events are commonly transient and reversible, indicating a promising option for OCD patients who do not respond to drug treatment or psychotherapy.

关 键 词：强迫性障碍 立体定位技术 腹侧内囊 有效性 安全性 

分 类 号：R749.7[医药卫生—神经病学与精神病学]