立体定向毁损术治疗难治性强迫症的临床分析(附12例报告)

Clinical analysis of stereotactic surgical treatment of treat-resistant obsessive compulsive disorder

目的探讨立体定向术治疗难治性强迫症的疗效及术后认知功能变化。方法回顾性分析12例行立体定向双侧内囊前肢射频毁损术的难治性强迫症患者的临床资料。分析手术前与术后6个月耶鲁-布朗强迫症状量表(Y-BOCS),韦氏成人智力测验(WAIS-RC)中相似性、木块图测验;韦氏成人记忆测验(WMS-R)中逻辑记忆(即刻、延迟)、视觉再生(即刻、延迟),威斯康辛卡片分类测验—改良版(M-WCST)分值。结果术后Y-BOCS量表评分5.00(1.00,12.25)比术前25.00(20.25,32.00)明显降低(Z=7.309,P<0.05),大部分认知功能测验分值与术前相比无明显变化(P>0.05),而术后即刻逻辑记忆20.00(12.50,24.00)、延迟逻辑记忆16.50(11.50,21.75)、即刻视觉再生12.00(11.00,14.00)、延迟视觉再生11.00(8.50,14.00)、木块图36.50(29.75,46.75)比术前即刻逻辑记忆14.00(13.00,18.75)、延迟逻辑记忆14.50(8.75,17.00)、即刻视觉再生11.00(6.50,11.75)、延迟视觉再生8.50(6.25,10.00)、木块图30.50(21.00,41.50)均明显改善(P<0.05)。结论 MRI引导下立体定向双侧内囊前肢毁损手术,对难治性强迫症是一种有效、安全的治疗方法,术后记忆等部分认知功能改善。

Objective To investigate the therapeutic effect of stereotactic surgical treatment and postoperative cognitive functions in patients with treat-resistant obsessive compulsive disorder（TRO）. Methods Twelve patients with TRO receiving MRI stereotactic bilateral anterior capsulotomy was retrospectively studied. The evaluation was conducted using the Yale-Brown obsessive compulsive rating scale （Y-BOCS）,Wechsler Adult Intelligence Scale-Revised in China （WAIS-RC）,Wechsler Memory Scale-Revised in China（WMS-R）, Modified Version of Wisconsin Card Sorting Tests （M-WCST） before and 6 months after the operation. Results The scores of Y-BOCS was 5.00（1.00,12.25） and 25.00 （20.25,32.00） after and before surgery, respectively. The scores of Y-BOCS were significantly lower after surgery than before （P〈0.05）. Most of cognitive function tests were not significantly different in TRO between pre-operation and 6 month post-operation （P〉0.05）.There were significant improvements in several cognitive tests after surgery including im-mediately logical memory 20.00（12.50,24.00）,delayed logical memory16.50（11.50,21.75）,immediately visual reproduc- tion 12.00（11.00,14.00）,delayed visual reproduction11.00（8.50,14.00） and block design test scores 36.50（29.75,46.75）, immediately logical memory14.00（13.00,18.75）,delayed logical memory 14.50 （8.75,17.00）,immediately visual reproduc-tion 11.00（6.50,11.75）,delayed visual reproduction 8.50（6.25,10.00） and block design test scores 30.50（21.00,41.50） （P〈0.05）. Conclusions MRI-guided bilateral anterior internal capsulotomy is effective and safe treatment for patients with TRO and can improve their cognitive function.