扣带回不同区域毁损对精神障碍疗效影响研究

Clinical study of the efficiency in stereotactic surgery for stubborn mental disorders with different target structures of Callosal gyrus

目的探讨扣带回靶点定位的不同选择在立体定向手术治疗顽固性精神障碍中的临床意义。方法运用立体定向技术,螺旋CT与坐标定位相结合计算靶点坐标值,根据扣带回毁损位点的不同,将2005年6月至2007年5月间86例顽固性精神障碍患者分成研究组(靶点前移组)和对照组,行同期双侧杏仁核加扣带回多靶点组合射频热凝毁损治疗。采用全国精神外科协作组1990年制定的评定方法对结果进行评定。结果两组临床效果差异无统计学意义,扣带回靶点前移组较对照组尿失禁发生率减少(P<0.05)。结论同期双侧杏仁核加扣带回多靶点毁损治疗顽固性精神障碍临床效果显著,扣带回靶点适当前移可明显降低尿失禁发生率。

Objective To explore the postoperative results of stereotactic surgery for stubborn mental disorders with the different target structures of Callosal gyrus. Methods 86 cases of stubborn mental disorders during the period between June, 2005 and May, 2007 operated by unstaged bilateral callosal gyrus and bilateral amygdale stereotactic radiofrequency lesion. Spatial coordinates of the target structures was calculated with CT-guided localization directly and stereotactic headframe indirectly. With the different target structures of Callosal gyrus, we dispart the study cases into two groups , antedisplacement group and control group. All were assessed with the criterion constituted by National Psychosurgery Cooperation of China in 1990 for clinical symptoms. Results No different efficiencies were showed between the two groups. The occurrence of the complications of urinary incontinence in the antedisplacement group was much lower than the control group （P〈0. 05）. Conclusion The clinical effects of unstaged bilateral callosal gyrus and bilateral amygdale dstereotactic raiofrequency lesion operation are predominant, whereas the antedisplacement of the target structures of Callosal gyrus will decrease the incidence of the complication of urinary incontinence significently.