立体定向辅助下双侧内囊前肢毁损术治疗难治性精神分裂症伴发的攻击行为的疗效

Clinical efficacy of stereotactic capsulotomy for impulsive aggressive behavior of patients with refractory schizophrenia

目的探讨立体定向辅助下双侧内囊前肢毁损术(ALIC-RSF)治疗难治性精神分裂症(SCZ)伴发的攻击行为的疗效。方法回顾性分析2019年6月至2021年1月立体定向辅助下ALIC-RSF治疗的35例伴攻击行为的难治性SCZ的临床资料。术前、术后3个月、术后1年,使用外显攻击量表(MOAS)、阳性及阴性症状量表(PANSS)、蒙特利尔认知评估量表(MoCA)、社会功能缺陷筛选量表(SDSS)评估疗效。使用R软件,采用LASSO回归分析检验PANSS评分与术后12个月MOAS评分的相关性。结果术后3、12个月,MOAS评分、PANSS评分、SDSS评分均显著改善(P<0.05),而MoCA评分无明显变化(P>0.05)。手术相关并发症大多在术后2周恢复,2例术后1年表现轻度行为懒散、兴趣缺乏的症状。术后12个月MOAS评分改善率与PANSS阳性评分改善率、术前PANSS子项被害评分呈明显正相关(P<0.05),而与PANSS子项交谈缺乏自发性和流畅性评分、不合作评分以及年龄呈明显负相关(P<0.05)。结论ALIC-RSF对难治性SCZ的攻击行为有确切疗效,可明显提高病人的社会功能和生活质量。

Objective To investigate the clinical efficacy of stereotactic bilateral capsulotomy(SBC) for the impulsive aggressive behaviors of patients with refractory schizophrenia(SCZ). Methods The clinical data of 35 patients with SCZ associated with aggressive behavior who were treated with SBC from June 2019 to January 2021 were retrospectively analyzed. The clinical efficacy were assessed by modified overt aggression scales(MOAS), positive and negative symptom scale(PANSS), Montreal cognitive assessment scale(MoCA)and social disability screening scale(SDSS). R software and LASSO regression analysis were used to analyze the correlation between PANSS score and MOAS score 12 months after the surgery. Results Three and 12 months after the operation, the MOAS, PANSS and SDSS scores were significantly improved(P<0.05), but the MoCA score had no significant change(P>0.05). Most of the surgery-related complications recovered within 2 weeks after the surgery. Mild laziness and lack of interest occurred in 2 patients 1 year after the surgery. The improvement rate of MOAS score 12 months after the surgery was significantly positively correlated with the improvement rate of the PANSS positive score and the pre-operative victimization score of PANSS(P<0.05), and was significantly negtively correlated with the patients’ age and the pre-operative scores of conversation lacking spontaneity and fluency and uncooperative of PANSS(P<0.05). Conclusions SBC has significant curative effect on the aggressive behavior of patients with refractory SCZ, and can significantly improve the patients’ social function and quality of life.