摘要
目的应用GE3.0T磁共振探讨立体定向伏隔核射频毁损术的靶点准确性、毁损范围与疗效、并发症的关系。方法根据统一参数,利用3.0TMR复查曾接受立体定向伏隔核射频毁损术的药物依赖患者55例。利用计算机工作站精确计算毁损灶中心坐标及毁损灶体积,根据手术前后的心理测评及术后随访,结合统计学,综合分析毁损术的靶点准确性、毁损范围与疗效、并发症的关系。结果无复吸无特异性并发症者27例,无复吸有特异性并发症者14例,复吸无特异性并发症者10例,复吸有特异性并发症者4例,总体有效率74.5%,复吸率25.5%。最佳疗效组毁损灶中心平均坐标为:X(6.2±0.4)mm,Y(22.7±1.2)mm,Z(-5.3±1.5)mm,平均体积为:0.274cm3。特异性并发症中顺行性遗忘、动机形成障碍10例,性欲减退1例,情感障碍2例,嗅觉迟钝3例,一过性缄默症2例。特性并发症的持续时间为3个月至6个月,均为一过性。结论立体定向伏隔核射频毁损术可有效的治疗药物依赖。准确、适度的对壳部进行毁损是保证疗效减少并发症的基础。靶点定位不准确或毁损灶体积过小,对壳部毁损范围不够,导致手术效果不佳;靶点偏离或毁损灶体积过大影响周围相应的脑组织,可导致并发症的发生,其中并发症主要集中在伏隔核下位脑结构受累的情况。
Objective To explore the correlation of the therapeutic effect and complications with the quality of target location and volume of the lesion in stereotactic radiofrequency surgery of nucleus accumbens for drug abstinence.Methods The clinical materials of 55 volunteers of drug addict who underwent stereotactic radiofrequency lesioning of the nucleus accumbens were retrospectively studied.Postoperative 3.0T MRI measured the average size of the lesion focus and average coordinate data of the lesion center.The relationship of the location and size of the lesion focus with the efficacy and complications was investigated according to statistics.Results Non-relaps with no complications were achieved in 27 cases,non-relaps with complication s in 14,relaps in 10,and relaps with complications in 4.Total effective rate was 74.5%,relapse rate was 25.5%.The coordinate of the best effective target within nucleus accumbens was as follows：X was（6.2±0.4）mm,Y（22.7±1.2）mm,Z（-5.3±1.5）mm.complications were as follows：anterograde amnesia and intention formation dysfunction in 10 cases,loss of sexual desire in 1,emotional disorder in 2,insensitivity of olfaction in 3 and temporary mutism in 2.Conclusion Stereotactic radiofrequency surgery of nucleus accumbens can effectively treat drug abstinence.Accurate and measurable lesion to the ventromedial part of nucleus accumbens is the basic principle.The efficacy and complications are associated withthe location and volume of the lesion focus.Deviate target or too small lesion focus will be of no effect.Both a lesion deviating from the effective target point and too big lesion focus will induce occurrence of complications.
出处
《立体定向和功能性神经外科杂志》
2010年第3期160-163,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
药物依赖
伏隔核
立体定向技术
磁共振
Drug addiction
Nucleus accumbens
Stereotaxic techniques
MRI
