立体定向毁损术治疗难治性精神分裂症的随访研究

A prospective follow up study of therapeutics effect on intractable schizophrenia by stereotactic technique

目的探讨立体定向毁损杏仁核不同亚核团和扣带回治疗难治性精神分裂症的可行性和疗效.方法对32例难治性精神分裂症患者,采用CRW立体定向仪和CT定位,用Radonics毁损仪毁损杏仁核不同亚核团和扣带回前部,采用临床疗效总评量表(CGI)、简明精神病量表(BPRS)和阳性与阴性症状量表(PANSS)和韦氏智力量表(WISC)等评定疗效,并进行1年的随访.结果显效20例,有效11例,无变化1例;术后BPRS和PANSS量表总分及各项因子分,比术前明显降低(t=6.36～15.96,均P＜0.01);韦氏智力测定总智商术后评分[(92.58±17.21)分]与术前评分[(90.61±16.52)分]比较,差异无显著性(t=0.54,P＞0.05).结论根据核心症状有选择地毁损杏仁核不同亚核团和扣带回,有助于提高难治性精神分裂症的手术效果.

Objective To investigate feasibility and effect of schizophrenia treatment by destroy different subnucleues of amygdale and front part of eallosal gyrus with stereotactic technique. Methods CRW stereo tactic apparatus and CT were used to define nucleus location and Radonics radiofrequeney instruments were used to lesion different subneucleus of amygdale and the front part of callosal gyrus. All schizophrenic patients were diagnosed by CCMD-3 standards. All cases with one year follow up, the effect were analysed with Clinical Global Impression （CGI） , the Brief Psychiatric Rating Scale （BPRS） ,and Positive and Negative Syndrome Scale （PANSS）. Results 20 cases were significantly improved, 11 cases improved, 1 case unchanged. There was significantly difference in the marks of PANSS and BPRS before and after stereotaetie technique （ P 〈 0.01 ）. There was no difference in intellect of patients with refractor＇ psychosis before and after stereotaetic technique （ P 〉 0.05 ）. Conclusion These results suggest selective destroying subnucleus of arnygdale according to different symptoms of schizophrenia could improve the curative effect of surgical treatment for schizophrenia.