脑立体定向多靶点毁损术治疗精神分裂症

Stereotactic brain multi-targets derogatied operation in the treatment of schizophrenia

目的探讨脑立体定向多靶点毁损术治疗精神分裂症的疗效。方法对精神分裂症患者行双侧扣带回、内囊前肢及杏仁核毁损术,并随访观察疗效。结果本组无围手术期死亡病例发生,术后发生并发症如下:①毁损灶出血8例,标准嗜睡和偏瘫,术后2周均吸收。②膀胱功能障碍,表现为尿失禁,其中1周内42例尿失禁症状自动消失,4例1个月内症状消失。③偏瘫8例,术后CT,MRI证实为基底节缺血性改变,扩张血管治疗后均恢复正常。术后随访1年,有效为43.5%,显效为42.5%,无效为14%。随访二年,有效为35.0%,显效为43.8%,无效为21.2%。结论脑立体定向多靶点毁损术治疗精神分裂症有一定的临床治疗效果,术后需适当服药及心理治疗。

Objective To investigate the curative effects on stereotactic brain multi-targets derogation operation in the treatment of schizophrenia.Methods From March 2000 to March 2004,28 cases with schizophrenia underwent derogated operation of bilateral cingulate gyrus,anterior crus of internal capsule and amygdoloid nucleus and it’s efficacies were observed.Results Postoperative complications were as follows:① The derogated lesion bleeding was found in 8 cases,which patients had symptoms of somnolence and hemiplegia.These bleeding lesions were absorbed two weeks after operation.②Vesical dysfunction was found in 46 cases and these patients had urinary incontinence.Among the symptom of 42 cases was disappeared within one week automatically and the symptom of other 4 cases was disappeared within I month.③ Hemiplegia was found in 8 cases.These patients within ischemic change of basal segment were confirmed by postoperative CT and MRI examination.Via dilated blood vessel treatment,the patients were recovered to normal status.Postoperative followup was got in 198 cases.The follow-up time was in one year and two years respectively.In the postoperative follow-up for 1 year,the significant effective rate,effective rate and ineffective rate were in 42.5%,43.5% and 14% respectively.In the postoperative follow-up for 2 year,the significant effective rate,effective rate and ineffective rate were in 43.8%,35.0% and 21.2% respectively.Conclusion Stereotactic brain multi-targets derogatied operation has a definite clinical efficacy for treating schizophrenia and a suitable taking medicine and psychotherapy are necessary after operation.