内囊前肢毁损术治疗难治性强迫症  

Anterior internal capsulotomy for refractory obsessive compulsive disorder.

作　　者：孙伯民[1] 李殿友[1] 朗黎琴[2] 潘力[2] 孙成彦[1] 李永超 张海音[4] 赵永波[5] 沈建康[1] 

机构地区：[1]上海瑞金医院神经外科,上海200025 [2]上海华山医院神经外科 [3]上海杨浦区精神卫生中心 [4]上海市精神卫生中心 [5]上海市第一人民医院神经科

出　　处：《中国神经精神疾病杂志》2003年第2期81-83,W002,共4页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的　探讨内囊前肢毁损术治疗难治性强迫症的临床疗效。方法　对 2 8例经精神科专科医师正规药物 心理 行为治疗无效的顽固性强迫症病人 ,采用MRI定位立体定向双侧内囊前肢毁损术 ,术中用电阻抗及高频电刺激验证靶点 ,80℃ / 6 0s射频破坏。术前术后由精神科医师进行Yale Brown强迫症量表、Hamilton抑郁量表、Hamilton焦虑量表评定及FDG PET检查。结果　 2 8例手术病人中 16例 (16 / 2 8)强迫症状完全消失 ,8例 (8/ 2 8)显著改善 ,4例 (4 / 2 8)无明显变化。并发症 :1例术中出现脑内血肿并破入脑室 ,经脑室引流及保守治疗后恢复 ;12例术后有轻度认知障碍及短暂记忆障碍 ,3～ 10d后恢复 ;2例术后有人格改变 ,表现情感淡漠 ,兴趣缺乏、懒散。在精神科量表检查中 ,焦虑、强迫及抑郁症状表量表分数均明显下降。结论　磁共振导向立体定向双侧内囊前肢毁损术定位精确、安全、显效迅速 ,对顽固性强迫症病人有明显疗效 ,是一种理想的替代治疗手段 ,除改善强迫症状外 ,它也能明显改善焦虑、抑郁症状。Objective To study the clinical effect of bilateral capsulotomy in patients with refractory obsessive compulsive disorder.Methods 28 cases of refractory obsessive compulsive disorder who had failed to anti OCD medications and psychological/behavior therapy underwent MRI guided stereotactic bilateral anterior capsulotomy. The target of the lesion was determined under high resolution MRI directly and was verified by intra operative impedance test. The lesions were generated by radiofrequency at 80℃ for 60 seconds. Pre and post operative Yale Brown obsessive compulsive rating scale, Hamilton depression rating scale, Hamilton anxiety rating scale were evaluated by psychiatrists. Some of the patients underwent FDG PET evaluation. Results In the 28 cases underwent operation, 16 cases had OCD symptoms free (57%), 8 cases had significant improvement (29%) and 4 cases had no significant improvement (14%). Psychiatric evaluations of rating scores demonstrated that there were significant decreases in Y BOCS and HAMD as well as HAMA. Complications included (1)intra cerebral hematoma occurred in 1 case patients which recovered after ventricular drain drainage age (2) post operative mild cognitive deficit and transient dysmnesia in 12 who all recovered within 3～10 days (3) personality change such as apathy and absence of interest as well as inactiveness in 2 cases .Conclusions MRI guided stereotactic bilateral capulotomy is a precise, safe, very effective therapy for refractory obsessive compulsive disorders. It is promised to improve the symptoms of OCD as well as anxiety and depression.

关 键 词：精神病 强迫症 内囊前肢毁损术 磁共振导向 治疗 

分 类 号：R749.7[医药卫生—神经病学与精神病学]