立体定向术治疗精神障碍11例

Treatment of mental disorders by stereotactic surgery: report of 11 cases

目的探讨立体定向术治疗精神障碍的疗效。方法回顾性分析经立体定向术治疗的11例精神障碍病人的临床资料,其中难治性强迫症7例,抽动秽语综合征3例,双相情感障碍1例。分析手术前后耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)分值、脑白质纤维束变化及脑葡糖代谢情况。结果术后6个月病人的各量表分值较术前均明显下降(均P<0.05),无严重并发症。大脑MRI弥散张量成像显示内囊前肢的横行纤维被毁损,大脑18F-FDG PET显示眶额皮质、运动区、运动前区、基底核、丘脑和边缘系统的高代谢区在术后明显降低。结论立体定向术是治疗难治性精神障碍的有效方法。

Objective To investigate the therapeutic effect of stereotactic surgery for mental disorders.Methods The clinical data of 11 patients with mental disorders who underwent stereotactic surgery,including 7 those with refractory obsessive-compulsive disorder,3 with tourette syndrome,1 bipolar affective disorder,were analyzed retrospectively.The pre-and post-surgical scores of the Yale-Brown obsessive compulsive rating scale（Y-BOCS）,Hamilton anxiety scale（HAMA）,and Hamilton depression scale（HAMD）,changes of brain white matter tracts and cerebral glucose metabolism were analyzed.Results The scores of the three scales significantly decreased 6 months after the surgery（all P0.05）.No severe complication occurred.Diffusion tensor imagination（DTI） showed that the transverse fibers of the anterior limb of the internal capsule were destructed.Brain 18F-FDG PET showed that metabolism decreased in the orbitofrontal cortex,motor area,premotor area,basal ganglia,thalamus and hypermetabolic areas of the limbic system postoperatively.Conclusions Stereotactic surgery is an effective treatment for mental disorders.