立体定向同期多靶点手术治疗难治性精神分裂症392例

Unstaged multi-target stereotactic radiofrequency lesion operation in 392 cases of intractable schizophrenia

目的探讨螺旋CT引导下同期双侧多靶点手术治疗难治性精神分裂症的疗效和并发症。方法采用螺旋CT直接定位和按坐标定位相结合方法计算靶点坐标值,术中用微电极进行电生理测定,记录阻抗值,对392例难治性精神分裂症患者,采用同期双侧多靶点射频热凝治疗。按全国精神外科协作组于1990年制定的评定方法进行疗效评定。结果392例患者术后2周随访:显著进步104例,进步274例,无效14例,加重0例,有效率96.4%;361例术后远期(6-24个月)随访:恢复26例,显著进步160例,进步154例,无效21例,加重0例,有效率94.18%。;术后除早期一过性并发症外,无远期严重并发症。结论螺旋CT引导同期双侧多靶点手术治疗难治性精神分裂症疗效显著,对阳性、阴性症状均有显著效果。

Objective To explore the effect and complications of unstaged bilateral multi-target radiofrequency lesion in the treatment of intractable schizophrenia. Methods 392 cases were studied. Spatial coordinates of the target structures was calculated with CT-guieded localization directly and stereotactic headframe indirectly. Using microelectrode record in the operation, therapeutic effect was estimated. Results After 2 weeks of operation to 392 cases： efficiency ratio 96.43%; after 6-24 months of operation to 361 cases： efficiency ratio 94.2%. Complication of stereotactic operation was recovered in a short time. Conclusions the efficency of unstaged bilateral multi-target operation is prominent. The radiofreguency target localization by combining CT-guided coordinates and stereotactic headframe is accurate and can reduce risk of complication.