立体定向手术戒毒后动机形成障碍原因分析及治疗

Pathogenesis analysis and therapy of motivation-forming dysfunction after stereotactic surgery for drug abstinence

目的分析立体定向双侧伏隔核射频毁损术后患者动机形成障碍的原因,以提高手术质量,指导康复治疗。方法随访术后反馈动机形成障碍的16例阿片类药物依赖患者,评估手术疗效,分析障碍的类型、程度、持续时间、转归过程,部分复查CT、MRI,总结靶点位置。结果注意力下降10例,主动性下降7例,交流减少6例,兴趣减少3例,12例多种障碍类型并存。3例伴有其他并发症者症状较轻。4例术后CT或MRI结果提示平均毁损灶体积约12mm×10mm×7mm。3个月以上的心理行为治疗可减轻障碍程度。结论该类并发症与毁损灶的部位过深、体积过大、反复用药后奖赏阈升高有关,通过靶点精确定位、毁损体积控制可能达到收益和风险的平衡。加强联合型学习是该并发症康复治疗的有效手段。

Objective To analyze the reasons for motivation-forming dysfunction in the patients after ablating the nucleus accumbens bilaterally by stereotactic surgery, so as to improve the operative quality and lead the rehabilitative therapy. Methods To follow up the 16 patients addicted to opiates who had been suffering motivation-forming dysfunction after operation, to analyze the type, degree, duration and prognosis of this kind of dysfunction and to inspect some of the patients by CT or MRI to summarize the location of the target. Results Aprosexia in 10 cases, lack of initiative in 7 cases, lack of communication in 6 cases, apathy in3 cases, multi-type coexistence in 12 cases. The symptoms were relieved in the 3 cases accompanied by other complications. The average lesion volume was almost 12mm×10mm×in the 4 cases according to postoperative CT or MRL Conclusions This kind of complication was associated with the immoderate depth and volume of the lesion focus and the elevation of reward threshold after repeated exposure to drugs. The balance of benefit/cost could be obtained through locating the target precisely and controlling the lesion volume. Enhancing the associative learning was an effective method for rehabilitative therapy for the complication.