立体定向手术治疗难治性抽动—秽语综合征  

Stereotactic surgery in the treatment of intractable Tourette's syndrome

作　　者：李玉辉[1] 赵开[1] 郝青峰 申立波 梁砚芳 

机构地区：[1]石家庄市第一医院神经外二科,050011 [2]河北省辛集市第二医院神经外科,052360 [3]无极人和医院神经外科,石家庄市052460 [4]石家庄市第一医院手术室,050011

出　　处：《临床合理用药杂志》2016年第32期11-12,20,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的总结立体定向下双侧内囊前肢射频毁损术治疗难治性抽动—秽语综合征(简称TS)的临床治疗效果,并对该方法的可行性和手术风险进行分析。方法选取医院精神科收治的难治性TS患者15例,术前均经过系统的精神科药物及心理行为治疗,仍不能控制症状,且在手术时绝大部分已过了青春期,症状表现严重,均为难治性TS。术前经CT和MRI检查除外神经系统器质性病变。所有患者采用CT引导立体定向下双侧内囊前肢射频毁损术。术前、术后6个月、1年由精神科医师采用国际通用的耶鲁综合抽动严重程度量表(YGTSS)对TS各项症状加以量化,对治疗效果进行评定。结果 15例TS患者在术后6个月、12个月随访时发现,运动抽动和发声抽动表现均有不同程度的改善。手术后YGTSS评分中运动抽动分数、发声抽动分数、总抽动严重程度分数均明显降低,与术前比较差异显著有统计学意义(P<0.01)。随访时发现YGTSS各项评估指标稳定,反映了持续改善的手术效果。术后早期一侧肢体轻度偏瘫1例,保守治疗后恢复;其余患者无死亡、颅内出血等其他颅内并发症。结论立体定向下双侧内囊前肢射频毁损术治疗难治性TS病例是可行、有效的方法,并发症及不良反应少。Objective To investigate the clinical therapeutic effect of stereotactic combined multiple targets radiofre- quency lesion for intractable Tourette＇s syndrome, estimate the risk of Stereotactic combined multiple targets lesion. Methods 15 cases of patients＇diagnosis was intractable Tourettc＇s syndrome by psychiatrist with C CMD-2-R《 Chinese Classification and Diagnosis of Mental Disorders》. All patients referred to surgery were previous failed with multiple non surgical methods （ psyehopharmacological and behavioural therapy） , and mostly of them have exceeded youthhood, their symptom are severity, all were intractable. Before operation they were examined with Ct and MRI, except for modality neurol disease. Patients were trea- ted by stereotactic technique combined with CT and electric impedance methods with anterior limb of the internal capsule lesion by ridio -frequency thermocoagulation. All patients was followed-up 6 and 12months after operation, and were rated for tic severity by the Yale global tic severity scale（YGTSS）. Results Follow up 6 months and 12 months,15 ＂IS patients were find the motor tic and vocal tic all have different extent improvement. Quantitative evaluation： Compared with preoperative, the scores of motor tic, vocal tic and total tie in YGTSS score were significantly decreased after surgery, the difference was statistically significant（ P 〈 0. 01 ）. The stability of YGTSS various assessment indicators was found during follow-up,this Reflected the continuous improvement of the surgical results. Early postoperative, 1 cases of patients was with mild hemiplegia, who recovered after conservative treatment. There was no severity complication and sequela taken occurrenced. Conclusion Stereotactic radio-fre- quency lesion bilateral anterior limb of the internal capsule is an effective and safe method to treat the intractable Tourette＇s syndrome, with less complications and adverse reaction.

关 键 词：抽动—秽语综合征 立体定向 射频毁损术 

分 类 号：R726.5[医药卫生—儿科]