复发性躁狂症患者立体定向靶点毁损术治疗疗效观察

Stereotactic surgery on patients with affective on recurrent mania

目的探讨立体定向靶点毁损术治疗复发性躁狂症的疗效及安全性。方法对40例复发性躁狂症患者行立体定向杏仁核、扣带回、伏隔核靶点毁损术,分别在术前2天与术后2周、6个月、1年由精神科医师进行临床疗效总评量表(clinical global impression,CGI)、躁狂量表(bech-rafaelsen mania rating scale,BRMS)、阳性和阴性症状量表(positive and negative symptom scale,PANSS)及精神症状简明量表(brief psychiatric rating scale,BPRS)对疗效进行评定,采用日常能力量表(activies of daily living,ADL)、社会功能缺陷量表(social disabilityscreening schedule,SDSS)评估手术安全性。结果术后2周、6个月、1年与术前相比,临床疗效总评量表(CGI)、躁狂量表(BRMS)、阳性和阴性症状量表(PANSS)、精神症状简明量表(BPRS)、日常能力量表(ADL)及社会功能缺陷量表(SDSS)评分有明显差异(P<0.05或P<0.01),且无严重并发症和后遗症。结论立体定向杏仁核、扣带回、伏隔核靶点毁损术可以有效缓解患者躁狂状态,提高药物敏感性,明显改善患者生存质量。

Objective To analyze the therapeutic effect and Security of affective on mania in cure of stereotaetic surgery. Methods 40 patients who suffered affective on Recurrent Mania were treated by stereotactic technique combined with bilateral amygdaloid nuclei, callosal gyrus, nucleus accumbens septi lesion by radio-frequency thermocoagulation. The therapeutic effects were estimated with CGI, BRMS, PANSS,BPRS, ADL, SDSS at the second week, sixth month and the first year after surgery. Results The score of the CGI,BRMS,PANSS,BPRS,ADL and SDSS before surgery showed more score decrease compare with the second week and the sixth month and the first year after surgery （P〈0.05 or P〈 0.01）. Conclusion The stereotactic tech- nique with multiple locations was an effective and safe method to treat mania. It might be signifi- cant to relieve the mania, raise the sensitivity to anti-affective disorder drug and improve the quality of life.