MRI引导内囊前肢毁损治疗难治性精神分裂症

MRI-guided anterior internal capsule lesioning for refractory schizophrenia

目的探讨MRI引导的内囊前肢毁损术治疗难治性精神分裂症的疗效。方法回顾性分析20例难治性精神分裂症病人的临床资料。所有病人均在MRI引导下,行立体定向内囊前肢毁损术。应用临床疗效总评量表(CGI)、简明精神量表(BPRS)、阳性与阴性症状量表(PANSS)及个人和社会功能量表(PSP)等分别在术前及术后3年评定疗效。结果术后3年,临床痊愈或显著改善12例,改善5例,无效3例;其中3例完全停用抗精神病药。术后BPRS、PANSS和PSP量表总分和(或)各项因子评分均比术前明显降低(均P<0.01)。结论 MRI引导的立体定向内囊前肢毁损手术,对难治性精神分裂症是一种有效、安全的治疗方法。

Objective To investigate therapeutic effect of MRI-guided stereotactic anterior internal capsule lesioning in refractory schizophrenia.Methods The clinical data of 20 patients with refractory schizophrenia were analyzed retrospectively.MRI-guided stereotactic anterior internal capsule lesioning was performed in all the patients.Clinical global impressions ratings（CGI）,brief psychiatric rating scale（BPRS）,positive and negative symptom scale（PANSS）,and personal and social performance scale（PSP） were employed to evaluate surgical outcome before and 3 years after the surgery.Results Twelve patients were cured or improved significantly,5 improved and 3 invalid 3 years after the operation.Three patients stopped use of antipsychotic medication.Total scores and/or individual index scores in postoperative BPRS,PANSS and PSP were significantly improved（all P0.01）.Conclusions MRI-guided stereotactic anterior internal capsule lesioning is an effective and safe treatment for refractory schizophrenia.