定向伏隔核射频毁损戒毒的毁损情况与疗效关系探讨

Exploration of correlation between the therapeutic effect and stereotactic radiofrequency lesioning of nucleus accumbens for drug abuse

目的探讨定向伏隔核射频毁损术戒毒中毁损灶的位置、大小与疗效、并发症的关系。方法回顾性分析接受定向伏隔核射频毁损戒毒手术后随访期达1年以上的60例志愿者的病历资料,复查MRI,测量毁损灶中心平均坐标值及毁损灶的平均大小,参照Schaltenbrand-Bailey人脑标准图谱,探讨毁损灶的位置、大小与疗效、并发症的关系。结果失访2例(3.3%)。疗效优27例(45.0%),良10例(16.7%),无效17例(28.3%),差4例(6.7%);总有效率61.7%,复吸率35.0%。伏隔核内有效靶点的平均坐标值分布趋势:x(6.5±0.5)mm,y(21.5±1.0)mm,z(-8.5±1.5)mm;最佳毁损灶平均大小为8mm×10mm×6mm,占整个伏隔核体积的1/3。中远期特异并发症包括顺行性遗忘、动机形成障碍10例,性欲减退1例,情感障碍1例,冲动行为1例,嗅觉迟钝1例;发生率为23.3%。结论定向伏隔核射频毁损戒毒的有效靶点位于伏隔核腹内侧的壳部,疗效及中远期特异并发症与毁损灶具体位置的设定及体积大小有关。毁损灶体积过小,导致手术无效;毁损灶偏离有效靶点,或毁损体积过大,均可导致并发症的发生。

Objective To explore the correlation of the therapeutic effect and complications with the location and volume of the lesion in stereotactic radiofrequency surgery of nucleus accumbens for drug abstinence. Methods The clinical materials of 60 volunteers of drug addict who underwent stereotactic radiofrequency lesioning of the nucleus accumbens with follow-up over I year were retrospectively studied. Postoperative MRI measured the average size of the lesion focus and average coordinate data of the lesion center. The relationship of the location and size of the lesion focus with the efficacy and complications was investigated according to the Schaltembrand-Bailey human brain atlas. Results Excellent therapeutic effect was achieved in 27 cases （45.0%）, good in 10 （16.7%）, inefficacy in 17 （28.3%）, and poor in 4 （6.7%）. Total effective rate was 61.7%, relapse rate was 35.0%, and 2 cases （3.3%） lost follow-up. The distribution trend of effective target coordinate value within nucleus accumbens was as follows： x was （6.5＋0.5） mm, y （21.5＋1.0） mm, z （-8.5＋1.5） mm. Mean size of the optimal lesion was 8 mm × 10 mm × 6 mm, accounting for one third of total volume of nucleus accumbens. The main clinical manifestations of middle and long term specific complications with the incidence rate of 23.3% were as follows： anterograde amnesia and intention formation dysfunction in 10 cases, loss of sexual desire in 1, emotional disorder in 1, excitatory action in 1 and insensitivity of olfaction in 1. Conclusion Effective target point of nucleus accumbens located at its ventromedial part. The efficacy and complications are associated with the location and size of the lesion focus. Too small lesion focus will be of no effect. Both a lesion deviating from-the effective target point and a too big lesion focus will induce occurrence of complications.