摘要
目的:观察立体定向同期双侧8靶点毁损手术对难治性精神分裂症患者精神情感状态的影响,并探讨手术的远期疗效及其安全性和不良反应。方法:于2003-01/2004-06选择解放军第四六三医院神经外科拟接受手术治疗的难治性精神分裂症患者392例为观察对象。实施螺旋CT引导下同期双侧8靶点射频热凝毁损手术,手术前及手术后2周进行相关量表量化评估。①采用简明精神病评定量表评定手术前后焦虑抑郁、缺乏活力、思维障碍、激活性、敌对猜疑的改善情况。②采用阳性症状量表评定幻觉、妄想、怪异行为、阳性思维障碍的改善情况;采用阴性症状量表评定情感平淡迟钝、思维贫乏、意志缺乏、兴趣社交缺乏、注意障碍的改善情况。③采用简易智力状态检查量表评定手术对智力是否有影响。④远期疗效随访评定按全国精神外科协作组于1990年制定的评定方法。评估标准:Ⅰ恢复:症状完全消失,功能正常,能适应生活,不需任何治疗。Ⅱ显著进步:症状基本消失,功能基本正常,能适应生活不需任何治疗,或在维持药物治疗下达到Ⅰ级水平。Ⅲ进步:症状减轻,功能有所缺陷,在生活适应方面还有各种问题,或在较大量药物治疗下达到Ⅱ级水平。Ⅳ无效:症状无变化。Ⅴ加重:症状加重。其中Ⅰ、Ⅱ、Ⅲ级称有效,Ⅳ、Ⅴ级为无效。并对3种量表评估结果进行对比分析。结果:392例患者均完成手术治疗及手术前和手术后2周的量表评估。①手术后简明精神病评定量表总评分明显低于手术前(36.38±8.57,56.13±11.24,t=29.57,P<0.01)。焦虑抑郁、缺乏活力、思维障碍、激活性、敌对猜疑等精神症状的手术后评分也显著低于手术前。②手术后阳性症状量表总评分明显低于手术前(21.36±5.67,64.13±13.24,t=35.07,P<0.01)。幻觉、妄想、怪异行为、阳性思维障碍的手术后评分也显著低于手术前。③手术后阴性症状量表总评分明显低于手术前(23.12±4.79,40.16±11.34,t=21.85,P<0.01)。情感平淡迟钝、思维贫乏、意志缺乏、兴趣社交缺乏、注意障碍的手术后评分也显著低于手术前。④手术后简易智力状态量表评分与手术前接近(25.89±2.61,25.66±3.01,P>0.05)说明手术对智力无损害。⑤手术后远期随访结果:术后1年随访,因地址及电话变更失访37例,随访355例中,恢复41例,显著进步184例,进步107例,无效23例,加重0例,有效率93.52%。⑥术后除早期一过性并发症外,无远期严重并发症。结论:同期双侧立体定向8靶点毁损手术显著改善难治性精神分裂症患者的焦虑抑郁、缺乏活力、思维障碍、激活性、敌对猜疑等精神情感状态,对阳性症状(幻觉、妄想、怪异行为、阳性思维障碍)及阴性症状(情感平淡迟钝、思维贫乏、意志缺乏、兴趣社交缺乏、注意障碍)有显著的改善作用,远期疗效稳定,安全性高。
AIM： To observe the effect of bilateral-8-target radiofrequency lesion operations on the psychiatric symptoms of patients with intractable schizophrenia, and investigate the long-term effect and safety as well as the adverse reaction of the operation. METHODS： Totally 392 cases, who were treated with CT-guided localization bilateral-8-target stereotactic operation in the Department of Neurosurgery, the 463 Hospital of Chinese PEA from January 2003 to June 2004, participated in the study. Before operation and 2 Weeks after operation, the patients were quantitatively assessed with related scales. ① The preoperative and postoperative ameliorations of anxiety and depression, deficiency of activity, thought disturbance, activation, hostility and suspicion were assessed with the scale of concise psychosis. ②The amelioration of illusion, delusion, strange behavior and positive thought disturbance were evaluated with scale for the assessment of positive symptoms （SAPS）. The improvements of flat affect and retardation, poverty of thought, abulia, lack of interest and social communication, and disturbance of attention were evaluated with scale for the assessment of negative symptoms （SANS）. ③ The mini-mental state examination （MMSE） was applied to assess whether the operation was effective for the intelligence. ④ The evaluation of long-term effect follow-up was conducted according to the methods set by the National Psychosurgery Association in 1990. Evaluation standards： Ⅰ was recovery： the symptoms disappeared completely, function was normal, adaptive to living, need not any treatment; Ⅱ was significant improvement： the symptoms disappeared generally, function was generally normal, adaptive to living, need not any treatment, or reached the level Ⅰ under the drug therapy; Ⅲ was improvement： the symptoms were relieved, function had some deficits, had various problems in the adaptation of living, or reached the level Ⅱ under the great amount of drug therapy; Ⅳ was invalid： the symptoms had no change; Ⅴ was aggravation： the symptoms were aggravated; the grades Ⅰ, Ⅱ, m were taken as valid, but Ⅳ and Ⅴ as invalid. The evaluation results of the 3 scales were comparatively analyzed. RESULTS： All the 392 patients completed the operation and the evaluation with scales before operation and 2 weeks after operation ①The postoperative total score of the concise psychosis scale was obviously lower than the preoperative one （36.38±8.57, 56.13±11.24, t=29.57, P 〈 0.01）. The postoperative scores of anxiety and depression, deficiency of activity, thought disturbance, activation, hostility and suspicion were significantly lower than the preoperative ones. ② The postoperative total score of SAPS was obviously lower than the preoperative one （21.36±5.67, 64.13±13.24, t=35.07, P 〈 0.01）. The postoperative scores of illusion, delusion, strange behavior and positive thought disturbance were significantly lower than the preoperative ones. ③ The postoperative total score of SANS was obviously lower than the preoperative one （23A2±4.79, 40.16±11.34, t=21.85, P 〈 0.01）. The postoperative scores of flat affect and retardation, poverty of thought, abulia, lack of interest and social communication, and disturbance of attention were significantly lower than the preoperative ones.④ The postoperative score of MMSE was close to the preoperative one （25.89±2.61, 25.66±3.01, P 〉 0.05）, it indicated that operation did no harm to the intelligence. ⑤ The results of the postoperative long-term follow-up： For the1 year post-operative follow-up, 37 cases lost to the follow-up because of the change of address and phone number. Of the 355 cases being followed up, 41 recovered, 184 had significant improvements, 107 had improvements, 23 were invalid, and 0 was aggravated. The valid rate was 93.52%. ⑥ There were no long-term server complications of stereotactic operation except of the early period complications. CONCLUSION： The efficiency of bilateral-8-target operation can greatly improve the psychiatric symptoms of anxiety and depression, deficiency of activity, thought disturbance, activation, hostility and suspicion in patients with intractable schizophrenia, it also can significantly ameliorate their positive symptoms （lusion, delusion, strange behavior and positive thought disturbance） and negative symptoms （fiat affect and retardation, poverty of thought, abulia, lack of interest and social communication, and disturbance of attention）. It has stable long-term effect and high safety.
出处
《中国临床康复》
CSCD
北大核心
2005年第36期60-62,共3页
Chinese Journal of Clinical Rehabilitation
