立体定向手术治疗难治性精神疾病的疗效和安全性分析

Safety and efficacy of stereotactic surgery in refractory mental disorders

目的探讨立体定向手术治疗难治性精神疾病的疗效和安全性。方法回顾性收集武汉大学人民医院神经外科自2019年8月至2023年12月采用立体定向手术治疗的149例难治性精神疾病患者的临床资料,记录其术后并发症发生和服药情况。术后1、6、12、24个月使用临床疗效总评量表-疗效总评(CGI-GI)评估患者的总体疗效。术前及术后1、6、12个月使用临床疗效总评量表-病情严重程度(CGI-SI)评估患者的病情严重程度,通过蒙特利尔认知评估量表(MoCA)评估患者的认知,通过阳性和阴性症状量表(PANSS)评估患者的阳性症状和阴性症状,通过简明精神病量表(BPRS)、90项症状自评量表(SCL-90)评估患者的精神病性症状,通过耶鲁-布朗强迫症状量表(Y-BOCS)评估患者的强迫症状,通过贝克抑郁问卷-II(BDI-II)评估患者的抑郁症状,通过贝克焦虑量表(BAI)评估患者的焦虑症状,通过杨氏躁狂量表(YMRS)评估患者的躁狂症状,通过社会功能缺陷筛选量表(SDSS)评估患者的社会功能,通过世界卫生组织生存质量测定简表(WHOQOL-BREF)评估患者的生存质量。结果(1)术后1周内出现睡眠增多47例、疲乏38例。术后1个月时6例患者仍存在行为懒散、情感淡漠,其余患者的并发症均消失。术后12个月时5例患者存在轻度主动性降低。(2)CGI-GI评估结果显示:术后1个月随访149例患者,总体有效率为85.90%;术后6个月随访135例患者,总体有效率为83.21%;术后12个月随访106例患者,总体有效率为79.24%,术后24个月随访63例患者,总体有效率为80.95%。(3)与术前比较,术后1、6、12个月患者BPRS评分较低,PANSS阳性、阴性、一般病性评分较低,BAI、BDI-II评分较低,YMRS评分较低,MOAS评分较低,Y-BOCS行为评分、思维评分、总分均较低,WHOQOL-BREF(生理、心理领域)评分较高,SDSS评分较低,SCL-90评分较低,差异均有统计学意义(P<0.05)。(4)术后12个月时13例患者停药,38例患者减药,52例患者服药剂量不变,2例患者服药剂量增加。结论立体定向手术可明显改善难治性精神疾病患者的强迫、焦虑、抑郁、躁狂、攻击等症状,提高患者的生活质量及社会功能,且安全性较好。

Objective To evaluate the clinical efficacy and safety of stereotactic surgery in patients with refractory mental disorders.Methods A retrospective analysis was performed;clinical data,postoperative complications and medication intake of 149 patients with refractory mental disorders accepted stereotactic surgery in Department of Neurosurgery,People's Hospital,Wuhan University from August 2019 to December 2023 were collected.Outcomes were assessed at 1,6,12,and 24 months after surgery by Clinical Global Impression-Global Improvement(CGI-GI).Before and 1,6,and 12 months after surgery,severities were assessed by Clinical Global Impression-Severity of Illness(CGI-SI);cognition was assessed by Montreal Cognitive Assessment(MoCA);positive and negative symptoms were evaluated by Positive and Negative Symptom Scale(PANSS);psychotic symptoms were evaluated by Brief Psychiatric Rating Scale(BPRS)and Symptom Checklist 90(SCL-90);obsessive-compulsive symptoms,depressive symptoms,anxiety symptoms and manic symptoms were assessed by Yale-Brown Obsessive-Compulsive Symptoms Scale(Y-BOCS),Beck Depression Inventory(BDI)-II,Beck Anxiety Inventory(BAI),and Young Mania Rating Scale(YMRS),respectively;social functioning and quality of survival were evaluated by Social Disability Screening Schedule(SDSS)and World Health Organization Quality of Life-Bref Form(WHOQOL-BREF).Results(1)Increased sleep was noted in 47 patients and fatigue in 38 patients within 1 week after surgery.Behavioral laziness and emotional apathy were still presented at 1 month after surgery in 6 patients,and complications disappeared in the rest patients.Mildly reduced initiative was presented at 12 months after surgery in 5 patients.(2)CGI-GI indicated that 149 patients were followed up 1 month after surgery with an overall efficiency of 85.90%;135 patients were followed up at 6 months after surgery with an overall efficiency of 83.21%,106 patients were followed up at 12 months after surgery with an overall efficiency of 79.24%,and 63 patients were followed up at 24 months after surgery with an overall efficiency of 80.95%.(3)Compared with those before surgery,significantly lower BPRS scores,significantly lower PANSS positive,negative,and overall scores,statistically lower BAI,BDI-II,YMRS,and MOAS scores,significantly lower Y-BOCS obsessional thinking,compulsive behavior and total scores,significantly higher WHOQOL-BREF(physical and psychological domains)scores,and significantly lower SDSS and SCL-90 scores were noted in patients at 1,6,and 12 months after surgery(P<0.05).(4)At 12 months after surgery,withdrawal drug was noted in 13 patients,reduced drug in 38,same dose in 52,and increased drug in 2 patients.Conclusion Stereotactic surgery can obviously improve obsession,anxiety,depression,mania and aggression,and modify social functioning and quality of survival in patients with refractory mental disorders,enjoying good safety.