立体定向多靶点毁损术治疗难治性神经性厌食的临床分析

Stereotactic multitarget lesion for intractable anorexia nervosa (analysis of 11 cases)

目的探讨立体定向颅内多靶点毁损术治疗难治性神经性厌食的疗效与安全性。方法在CT联合电阻抗定位下行核团射频热凝毁损术治疗难治性神经性厌食11例,其中9例行双侧杏仁核、内囊前肢加尾状核下束毁损术,2例行左侧杏核、双侧内囊前肢、尾状核下束毁损术,评估术前及术后3个月、6个月、1年患者临床症状、生理指标、心理测验及术后并发结果术后1年根据临床症状、生理指标、心理测验评价疗效:临床痊愈5例,显著进步4例,好转1例,复发1例;有效率为81(9/11)。11例均未出现明显的神经系统受损等严重并发症。结论立体定向双侧杏仁核、内囊前肢、尾状核下束毁损术治疗难性神经性厌食近期疗效好,并发症轻。

Objective To analyze the therapeutic effect of stereotactic multitarget lesion on intractable anorexia nervosa and its security. Methods Of 11 female patients with intractable anorexia nervosa, 9 underwent the stereotactic radiafrequency thermocoagulation of the bilateral amygdaloid nuclei, anterior limbs of internal capsules and subcaudate nuclei, and 2 the thermocoagulation of the left amygdaloid nuclei, anterior limbs of the bilateral internal capsules and subcaudate nuclei after the cerebral areas to be thermocoagulated were located by CT and electric impedance methods. The curative effects the patients were assessed by body mass index, pluse, blood pressure, menses, Wechsler adult intelligence scale revised in China, Wechslcr memory scale revised in China, Eysenck personality questionaire, activity of daily living scale, social disability screening schedule, Hamilton depression scale, Hamilton anxiety scale and Yale-Brown coercion scale before the operation and 3, 6 and 12 months after the operation. Results Following up 1 year after the operation showed that according to the clinical symptoms, physiological signs and psychological test, 5 patients were cured, 4 significantly improved in the clinical symptoms and signs, 1 improved and 1 relapsed 4 months after the operation. There were no serious operative complications during the following-up in all the patients. Conclusion The short-term curative effect of the stereotactic radiofrequency thermocoagulation of the bilateral amygdaloid nuclei, anterior limbs of the internal capsules and subcaudate nuclei on the intractable anorexia nervosa is good.