立体定向选择性多靶点组合毁损治疗难治性精神障碍

Stereotactic selective multi-target lesioning for patients with intractable psychiatric disorders

目的探讨立体定向选择性多靶点联合毁损治疗难治性精神障碍的靶点组合及疗效。方法回顾性分析立体定向手术治疗的43例难治性精神障碍患者的临床病例资料,所有病例均在MR引导下行选择性多靶点联合毁损,术前应用高场强核磁共振进行靶点定位,手术前后应用阳性与阴性症状量表(PANSS)、耶鲁-布朗强迫量表(Y-BOCS)、汉密尔顿焦虑量表(HAMD)、汉密尔顿抑郁量表(HAMA)等量表进行疗效评定。结果 43例精神障碍患者中,恢复6例,显著进步22例,进步13例,无效2例;各量表评定结果显示术后状评分较术前有显著下降,其中对阳性症状缓解较阴性症状更为明显。强迫症手术后强迫思维与行为评分都显著低于术前的评分(P<0.05),手术近期效果及长期疗效稳定。抑郁症手术前后抑郁症状和焦虑症状评分有差异性显著(P<0.05),以抑郁症状缓解为最明显,且远期疗效较稳定。结论立体定向手术是治疗难治性精神障碍一种有效方法,手术可以有效缓解患者精神症状,有利于患者社会功能恢复,对日常生活能力无明显影响;立体定向选择性多靶点联合毁损术微创、定位准确,可以明显提高手术安全,减少并发症。

Objective To explore target selection and long-term outcome of multi-target radiofrequency lesion operation in patients with intractable psychiatric disorders.Methods 43 patients with severe intractable psychiatric patients who underwent stereotactic ablative procedures.are analyzed retrospectively.MR-guided stereotactic selective multiple target lesioning were performed in all patients.The efficacy was evaluated with positive and negative symptom scale（PANSS）,Yale-Brown obsessive compulsive rating scale（Y-BOCS）,Hamilton anxiety scale（HAMA） and Hamilton depression scale（HAMD） at the pre-and post-surgery.Results Follow-up of 24 months after stereotactic ablative procedures,6 patients were cured,22 patients were classi？ed as responders,13 were partial responders and 2 did not respond to the surgical procedures.The scores of the scales（PANSS,Y-BOCS,HAMA,HAMD） significantly decreased after surgery（all P0.05）.Conclusion MR-guided selective multi-target operation is prominent in treatment of intractable disorder with high efficacy and safety.psychosurgery is helpful for patients to restore social function,and has no obvious effects on daily life.