脑立体定向手术治疗难治性精神分裂症的随访研究  

A follow-up study of brain stereotactic surgery in the treatment of patients with refractory schizophrenia

作　　者：王士良[1] 钱敏才[1] 沈鑫华[1] 陈静[2] 陈焕林[3] 葛陈捷 李建华[1] 钟华[1] 

机构地区：[1]浙江湖州市第三人民医院精神科,313000 [2]浙江湖州市第三人民医院神经内科,313000 [3]浙江湖州市第三人民医院外科,313000

出　　处：《临床精神医学杂志》2017年第3期191-193,共3页Journal of Clinical Psychiatry

摘　　要：目的:评价脑立体定向手术治疗难治性精神分裂症的长期疗效和安全性。方法:对2006~2008年间接受脑立体定向手术治疗的难治性精神分裂症患者34例,采用简明精神病量表(BPRS)、社会功能缺陷筛选量表(SDSS)、日常生活能力量表(ADL)等于术前、术后3周及术后8~10年进行访视。结果:完成访视26例,累积再住院率61.5%(16/26例);服药不规律者再住院率100%(7/7例);平均再住院次数为0~17次(中位数7次);使用抗精神病药折合氯丙嗪等效剂量术前、术后3周及末次访视时分别为[(595.2±107.9)、(208.2±101.0)、(396.4±276.3)mg/d]。术后3周及末次访视时BPRS总分及缺乏活力、思维障碍、激活性、敌对猜疑因子分较术前显著下降(F=8.671~79.552,P均<0.01或P<0.001);末次访视时SDSS总分、ADL总分及各因子分较术前显著下降(t=5.295~7.049,P均<0.001)。术后访视未见严重的手术并发症。结论:难治性精神分裂症患者脑立体定向术后精神症状及生活质量有所改善,手术安全性好;但再住院率较高,仍需长期使用抗精神病药维持治疗。Objective：To evaluate the long-term efficacy and safety of brain stereotactic surgery in the treatment of refractory schizophrenia.Method：Thirty four refractory schizophrenia patients who underwent brain stereotactic surgery from 2006-2008 were assessed by brief psychiatry rating scale（BPRS）,social disability screening schedule（SDSS）,and activity of daily living scale（ADL） before surgery,at the end of third week and 8-10 years after surgery.Results：Twenty six patients had been assessed three times.The cumulative rate of re-hospitalization was 61.5%（16/26）,and the rate of re-hospitalization in patients with irregular medication was about 100%（7/7）.The average number of re-hospitalization after the surgery was 0-17 times（median：7）.The average dosage equivalent to chlorpromazine was（595.2±107.9） mg/d,（208.2±101.0）mg/d,（396.4±276.3） mg/d before surgery,at the end of third week and at the last visit.The total score of BPRS,the lack of vitality,mental disorder,activation,and hostility factor were significantly decreased（F=8.671-79.522,P〈0.01 or P〈0.001） at the end of the third week after surgery and at the last visit.At the last visit,the SDSS total score,ADL total score and factors were all decreased significantly than before surgery（t=5.295-7.049,P〈0.001）.There were no serious complications after operation.Conclusion：Brain stereotactic surgery is safe and it can improve the psychosis symptoms and life quality of treatment refractory schizophrenia.However,the rate of re-hospitalization was still high and the patients still need long-term maintenance of antipsychotics.

关 键 词：难治性精神分裂症 脑立体定向手术 长期疗效 安全性 

分 类 号：R749.3[医药卫生—神经病学与精神病学]