选择性多靶点毁损治疗难治性精神病：154例报告

目的探讨脑立体定向下选择性多靶点毁损术对难治性精神病的临床治疗效果。方法对154例难治性精神病应用现代脑立体定向技术对颅内的多个靶点进行选择组合射频毁损治疗。术后随访6～24个月。应用临床疗效总评量表（CGI）、简明精神病症状分级评定量表（BPRS）、社会功能量表（SDSS）、阳性症状量表（SAPS）、魏克斯勒儿童智力量表（WISC）和临床记忆量表（CMS）对治疗效果进行评价。结果154例经CGI评定总有效率为90％（优22例，显著进步68例，进步50例，无变化14例）。手术前后BPRS分别为68．86±14．40和32．40±8．66；SAPS为26．54±2．28和9．96±2．54；SDSS为15．82±1．20和8．62±1．60，均有明显差异（P〈0．01或P〈0．05）；CMS、WISC检测术前与术后无显著差异。本组术后均无严重并发症和后遗症。结论脑立体定向技术微创、安全，是难治性精神病的有效治疗方法；根据不同的症状设计不同的靶点组合，对提高疗效、降低并发症有较大意义。

Treatment of intractable psychosis with stereotactic selective multiple target lesion:report of 154 cases

Objective To investigate the clinical therapeutic effect of stereotactic selective multiple target lesion for the intractable psychosis. Methods A total of 154 patients with intractable psychosis were treated by stereotactic selective multiple targets radiofrequency lesion and were followed-up from 6 to 24 months after operation. All patients were assessed with brief psychiatric rating scale （BPRS）, social disability screening schedule （SDSS）, symptom and positive scale （SAPS）, Wechsler intelligence scale for children （WISC）, clinical memory scale （CMS） and clinical global impression （CGI）. Results The total efficiency was 90% （22 patients cured, 68 patients obviously improved, 50 patients improved and 14 patients invalid）. The scores of BPRS were 68.86 ± 14. 40 for pre-opemtion and 32.40 ± 8.66 for post-operation; the scores of SAPS were 26.54 ± 2.28 for pre-operation and 9. 96 ±2.54 for post-operation; the scores of SDSS were 15.82 ± 1.20 for pre-operation and 8.62 ± 1.60 for post-operation. BPRS, SAPS and SDSS showed obvious significant statistical difference between pre-operation and post-operation （P 〈 0.01, P 〈 0.05 ）, while there was no significant difference in CMS and WISC between pre-operation and post-operation. There were no serious complications and sequels after operation. Conclusion ＇Pne present study suggests that the stereotactic selective multiple target lesion is a safe and effective therapy for intractable psychosis. Choosing different targets according to different symptoms can improve the efficiency and reduce the complication.