摘要
目的探讨多靶点立体定向手术在难治性精神病的应用。方法选择49例难治性精神病且接受多靶点立体定向手术治疗的患者,于手术后6、12个月对患者进行随访,采用简明精神病评定量表(BPRS)、阳性与阴性症状评定量表(PANSS)及韦氏智力量表(WISC)对患者随访时进行评估。于治疗后6个月采用1990年全国精神外科协作组指定的临床疗效评定标准对疗效进行评价。结果手术后6个月随访47例,随访率为95.9%,手术后12个月成功随访44例,随访率为89.8%。手术后6、12个月BPRS量表、PANSS量表总分及各项因子评分均低于手术前,差异有统计学意义(P<0.05),手术后精神症状较手术前明显改善。手术后6、12个月BPRS量表及PANSS量表及各项因子评分差异无统计学意义(P>0.05)。PANSS评分治疗后阳性量表、阴性量表评分均较治疗前降低。手术前与手术后6、12个月随访时言语智商、操作智商及全智商评分差异无统计学意义(P>0.05)。49例难治性精神病患者,毁损靶点包括扣带回+杏仁核+内囊前肢、扣带回+杏仁核+内囊前肢+内侧隔核、扣带回+杏仁核+丘脑背内侧核、扣带回+内囊前肢+尾状核下束的有效率分别为88.9%、77.8%、90.0%、83.3%。结论多靶点立体定向手术对阳性、阴性症状均能改善,并且手术对智力无影响。立体定向手术是精神病的较好治疗手段,对于靶点的选择倾向于联合靶点。
Objective To investigate the applications of multi-target stereotactic surgery in refractory psy-chosis and make an analysis of 1-year follow-up.Methods 49 patients with multi-target stereotactic sur-gery were selected and followed up in 6 months and one year after their surgery by Brief Psychiatric Rating Scale（BPRS）,Positive and Negative Syndrome Rating Scale（PANSS）and the Wechsler Intelligence Scale （WISC）to evaluate.The criteria of 1990 National Cooperative Group of Psychosurgery were used to evalu-ate the treatment of clinical efficacy after six month′s follow-up.Results 4 7 cases were followed-up after 6 months,with the follow-up rate of 9 5 .9%;4 4 cases were followed up 1 year after surgery,with the success-ful follow-up rate of 8 9 .8%.The scores of PANSS and BPRS scale at 6 months follow-up and 1 year follow-up were lower than before,especially in the item of hostile suspicion and activity,with the difference statistically significant （P 〈0 .0 5 ）.Psychiatric symptoms were improved after surgery in a year,but the score differences of the PANSS and BPRS scale were not statistically significant （P〉0 .0 5 ）.After the surgery,positive PAN-SS score scale and negative scale score were lower than before.Verbal IQ,performance IQ and full IQ scores showed no significant difference （P 〉0 .0 5 ）in the pre-operation and 6 months and 1 year post-operation fol-low-up.4 9 patients with refractory psychiatric patients,including the cingulate gyrus damage targets＋anterior limb amygdala,cingulate gyrus amygdala ＋ anterior limb medial septal nucleus,cingulate gyrus＋amygdala dorsomedial hypothalamic nucleus, cingulate gyrus＋ caudate anterior limb Nucleation beam, have the efficiency of 8 8 .9%,7 7 .8%,9 0 .0%,8 3 .3% respectively.Conclusion As a better treatment for mental illness,stereotactic surgery can improve the positive and negative symptoms with no effect on intelligence. Joint targets are preferred for the choice of targets.
出处
《新疆医科大学学报》
CAS
2013年第10期1501-1504,1508,共5页
Journal of Xinjiang Medical University
基金
中国人民解放军兰州军区医药卫生科研计划项目(CLZ13JA16)
关键词
难治性精神病
多靶点
立体定向
随访
refractory psychosis
multi-target
stereotactic
follow-up
