立体定向脑内多靶点联合毁损治疗精神分裂症

Treatment of Schizophrenia with Intracerebral Multi-Targets Stereotactic Lesions

目的观察立体定向脑内多靶点联合毁损治疗精神分裂症的近期疗效,并探讨其相关机制。方法对32例精神分裂症患者(20例为Ⅰ型精神分裂症患者,12例为Ⅱ型精神分裂症患者)脑内双侧多靶点(主要包括扣带回、内囊前肢及杏仁核)给予射频热凝治疗。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,并检测术前及术后4周患者脑脊液中神经递质多巴胺(DA)、5-羟色胺(5-HT)、去甲肾上腺素(NE)水平并与正常对照组相比较。结果术后4周随访:20例Ⅰ型精神分裂症患者显著进步13例,进步6例,无变化1例,有效率95.0%(19/20);12例Ⅱ型精神分裂症患者显著进步4例,进步5例,无变化3例,加重0例,有效率75.0%(9/12);术前Ⅰ型精神分裂症患者脑脊液中DA水平明显高于正常对照组(P<0.05),Ⅱ型精神分裂症患者脑脊液中5-HT水平明显高于对照组(P<0.05),NE水平两组精神分裂症患者与正常对照组比较差异无显著性(P>0.05);术后4周,Ⅰ型精神分裂症患者脑脊液中DA水平明显低于术前水平(P<0.05),Ⅱ型精神分裂症患者脑脊液中5-HT水平较术前也显著降低(P<0.05)。结论立体定向脑内多靶点联合毁损对Ⅰ型和Ⅱ型精神分裂症的治疗均有效;其作用机制可能与手术临时阻断边缘神经系统神经递质的传导通路,并且调节脑内DA、5-HT递质水平有关。

Objectives To explore the curative effect of the multi-targets stereotactic lesions on schizophrenia and its mechanism. Methods The radiofrequency thermocoagulations of intracerebral bilateral multi-targets including the cingulated gyri, amygdaloid nuclei and anterior limbs of the internal capsules and so on were performed in 32 patients with schizophrenia, of whom, 20 suffered from schizophrenia Ⅰ, and 12 schizophrenia Ⅱ. The contents of dopamine （DA）, 5-hydroxytryptanine （5-HT） and norepinephrine （NE） in the cerebrospinal fluid （CSF） before and 4 weeks after the operation were determined in all the patients and 20 patients with space-occupying lesions of spinal cords serving as control. Results The following up 4 weeks after the operation showed that of 20 patients with schizophrenia Ⅰ, 13 were significant improved in the symptoms, 6 lightly improved and 1 not improved （the effective rate was 95%）, and of 12 patients with schizophrenia Ⅱ, 4 were significant improved, 5 lightly improved, and 3 not improved （the effective rate was 75%） according to the schizophrenia assessment method made by the National Psychosurgery Group in 1990. The CSF level of DA in schizophreniaⅠ group was significantly higher before the operation than those in the control group and 4 weeks after the operation （P0.05）. The CSF level of 5-HT in schizophrenia Ⅱgroup was significantly higher before the operation than those in the control group and 4 weeks after the operation （P0.05）. The CSF level of NE in both the schizophreniaⅠand Ⅱ groups was insignificantly different from that in the control group before and 4 weeks after the operation （P0.05）. Conclusions The intracerebral multi-targets stereotactic lesions is of effect on both the schizophrenia Ⅰ and Ⅱ patients. Its mechanism may be related to the block of the limbic system pathways, i.e. decrease in the CSF levels of DA and 5-HT.