立体定向下核团毁损术及脑深部电刺激术治疗难治性强迫症

目的探讨MRI定位下核团毁损术及脑深部电刺激术治疗难治性强迫症的疗效。方法应用MRI定位下射频热凝核团毁损术及脑深部电刺激术治疗难治性强迫症49例，其中30例行双侧内囊前肢毁损术，13例行双侧扣带回加双侧内囊前肢毁损术,6例行右侧伏隔核脑深部电刺激术加对侧内囊前肢毁损术。手术前后应用YALE-BROWN强迫症状量表、汉密尔顿抑郁量表、汉密尔顿焦虑量表对手术效果进行评价。结果术后6个月均获随访，其中临床痊愈28例，显著改善9例，轻度改善7例，无明显变化5例。22例术后早期出现一过性并发症，均在术后2周内恢复。术后焦虑，强迫，抑郁症状量表分数均明显下降（P〈0．01）。结论MRI定位下核团毁损术及脑深部电刺激术治疗难治性强迫症有显著疗效，并发症较轻，可以显著改善病人强迫、焦虑、抑郁症状。

Clinical effect of stereotactic nucleus lesioning and deep brain stimulation for refractory obsessive-compulsive disorder

Objective To study the clinical effect of stereotactic nucleus lesioning and deep brain stimulation for refractory obsessive-compulsive disorder. Methods Forty-nine patients with refractory obsessive-compulsive disorder underwent MRI-guided stereotactic nucleus lesioning and deep brain stimulation. Thirty of them were treated by bilateral anterior capsulotomy, 13 by bilateral anterior cingulotomy and bilateral anterior capsulotomy and 6 by right side nucleus accumbens deep brain stimulation with left side anterior capsulotomy. Pre- and post- operative Yale-Brown obsessive-compulsive rating scale, Hamilton depression rating scale, and Hamilton anxiety rating scale were used by psychiatrists for evaluating the surgical effect. Results At follow-up of 6 months after operation, obsessive-compulsive disorder symptoms disappeared in 28 cases, significant improvement of the symptoms was seen in 9, improvement in 7 and no significant change in 5. There were mild post-operative complications in 22 cases, and all recovered within 2 weeks. Psychiatric evaluations by the rating scales demonstrated there were significant decreases in above scale scores for anxiety, compulsion and depressive symptoms (P <0.01). Conclusion MRI-guided stereotactic nucleus lesioning and deep brain stimulation are significantly effective in reducing anxiety, anxiety and depressive symptoms of refractory obsessive-compulsive disorder, with less complications.