内囊前肢毁损术治疗精神发育迟滞伴严重行为障碍:附1例报道并文献复习  

Anterolateral capsulotomy for mental retardation accompanied by severe behavioral disorders:a case report and literature review

作　　者：姜志锋 段蕾梅 刘辉 王黎华 JIANG Zhi-feng;DUAN Lei-mei;LIU Hui;WANG Li-hua(Department of Neurosurgery,North China Medical and Health Group Fengfeng General Hospital,Handan 056200,China;Department of Neurosurgery,Handan Hospital of Integrated Traditional Chinese Medicine and Western Medicine,Handan 056001,China;Mental Health Center,North China Medical and Health Group Fengfeng General Hospital,Handan 056200,China)

机构地区：[1]华北医疗健康集团峰峰总医院神经外科,河北邯郸056200 [2]邯郸市中西医结合医院神经外科,河北056001 [3]华北医疗健康集团峰峰总医院精神卫生中心,河北邯郸056200

出　　处：《中国临床神经外科杂志》2024年第10期605-607,共3页Chinese Journal of Clinical Neurosurgery

基　　金：邯郸市科学技术研究与发展计划项目(19422083012-3)。

摘　　要：目的探讨内囊前肢毁损术治疗精神发育迟滞伴严重行为障碍的疗效。方法回顾性分析立体定向内囊前肢单靶点毁损术治疗的1例精神发育迟滞伴严重行为障碍的临床资料,结合相关文献进行分析。结果本文报道1例29岁男性,早产儿,自幼出现精神发育迟滞,间断有躁动、喊叫等行为障碍,长期服用抗精神病药物控制。1.5年前,药物治疗效果转差,症状加重。充分评估后,行脑立体定向双侧内囊前肢单靶点毁损术。术后行为障碍症状消失,情绪稳定,继续服用丙戊酸镁缓释片。术后3~6个月,症状无复发,停用药物。术后42个月随访,手术效果维持良好。结论对于精神发育迟滞伴严重行为障碍,如果药物控制效果差,可考虑内囊前肢单靶点毁损术治疗。由于毁损术具有不可逆性,并且涉及伦理等问题,因此,合理选择手术病人、严格把握手术适应证尤为重要,建议与精神科医师、伦理学家等密切合作。Objective To evaluate the efficacy of anterolateral capsulotomy(AC)for patients with mental retardation accompanied by severe behavioral disorders.Methods A retrospective analysis was conducted on the clinical data of a patient with mental retardation associated with severe behavioral disorders who underwent stereotactic AC,and the related literatures were reviewed.Results This paper reports a 29-year-old male,a premature infant,who had mental retardation since childhood and intermittent behavioral disorders such as restlessness and shouting.Antipsychotic drugs were taken for a long time for control.One and a half years ago,the effect of drug treatment deteriorated and the symptoms worsened.After thorough evaluation,stereotactic bilateral single-target lesioning of the anterior limb of the internal capsule was performed.After the operation,the symptoms of behavioral disorders disappeared,the mood was stable,and magnesium valproate sustained-release tablets were continued.Within 3 to 6 months after the operation,there was no recurrence of symptoms,and the drugs were stopped.At the 42-month follow-up,the surgical effect remained good.Conclusion For mental retardation associated with severe behavioral disorders,if the effect of drug control is poor,AC can be considered.Due to the irreversibility of lesioning and issues related to ethics,it is particularly important to rationally select surgical patients and strictly grasp the surgical indications.It is recommended to closely collaborate with psychiatrists,ethicists,etc.

关 键 词：精神发育迟滞 行为障碍 内囊前肢毁损术 疗效 

分 类 号：R749[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]