双侧内囊前肢和扣带回毁损术治疗难治性强迫症(附34例临床分析)

Bilateral Anterior Internal Capsulotomy and Bilateral Anterior Cingulumotomy for Refractory Obsessive Compulsive Disorder

目的探讨双侧内囊前肢和双侧扣带回毁损术治疗难治性强迫症的临床疗效。方法对34例难治性强迫症患者,采用立体定向双侧内囊前肢与扣带回前部毁损术,并分别在术前与术后2周、6个月、1年、2年由精神科医师进行Y-BOCS、HAMA、HAMD量表评定以及术后疗效评定。5例患者在术后6个月因疗效不佳而接受二次手术。结果难治性强迫症患者术后各期Y-BOCS、HAMA、HAMD评分与术前比较均明显下降。术后6个月的总有效率(70.6%)明显低于术后2周的总有效率(94.1%),但术后1年、2年的总有效率与术后6个月的总有效率比较无明显差异。结论立体定向双侧内囊前肢与双侧扣带回前部毁损术对难治性强迫症患者疗效显著,并可保持较好的远期疗效。

Objective To study the clinical effect of bilateral anterior internal capsulotomy and bilateral anterior cingulumotomy on patients with refractory obsessive compulsive disorder （OCD）. Methods 34 cases of treat-resistant OCD were treated with stereotactic bilateral anterior internal capsulotomy and bilateral anterior cingulumotomy. Y - BOCS, HAMD, HAMA were evaluated by psychiatrists before, 2 weeks after, 6 months after, one year after, two years after the operation respectively. Five patients accepted second operation 6 months after the first surgery because of inefficient result. Results The total scores of Y- BOCS, HAMD, HAMA in all phases after operation were significantly lower than those before operation. The total efficiency of 6 months post- surgery （70. 6%） was significantly lower than that of 2 weeks postsurgery （94. 1%）, but there was no significant difference in the total efficiency among 6 months later, one year later, two years later post-surgery. Conclusion The treatment of refractory OCD with stereotactic bilateral anterior internal capsulotomy and bilateral anterior cingulumotomy is obviously effective, and the excellent longterm result can be maintained.