CAJ | 학술논문

目的探讨立体定向双侧内囊前肢毁损术治疗难治性强迫症的疗效、安全性及机制.方法回顾性分析四川大学华西医院神经外科自2009年1月至2014年1月行立体定向双侧内囊前肢毁损术的14例难治性强迫症患者的术前、术后3个月及6个月临床资料,比较手术前后磁共振弥散张量纤维束成像(DTT)、脑葡萄糖代谢(PET/CT)、症状相关量表及部分认知功能量表评分的变化. 结果术后3月DTT示内囊前肢联系前额叶与纹状体的前后纤维束大部分毁损,而术后6月部分纤维瘢痕修复再生.术后6月PET/CT显示眶额叶皮层(右:1.17±0.20,左:1.20±0.06)、腹内侧额叶皮层(右:1.20+0.02,左:1.18±0.07)、纹状体(右:1.17±0.04,左:1.12±0.06)、前扣带回(1.06±0.06)代谢较术前(右:1.41±0.19,左:1.40±0.16;右:1.26±0.02,左:1.23±0.08;右:1.35±0.10,左:1.37±0.12;1.23±0.07)降低,而枕叶皮层(右:1.58±0.14,左:1.63±0.21)与术前(右:1.39±0.14,左:1.41±0.15)相比代谢增加,差异均有统计学意义(P＜0.05);术后6月耶鲁-布朗强迫量表评分(9.00±4.94)、汉密尔顿焦虑量表评分(8.28±4.59)和汉密尔顿抑郁量表评分(6.14±2.24)分值较术前[(29.21±5.36、22.64±4.93、17.84±6.13)均明显下降,差异有统计学意义(P＜0.05);即刻/延迟逻辑记忆[(21.28±4.85)/(18.00±5.39)]、即刻/延迟视觉再生[(13.00±1.51)/(12.14±2.14)]及木块图测验(39.83±6.80)较术前[(17.21±5.61)/(14.00±5.34)、(10.00±3.35)/(8.64±3.52)、(31.50±10.76)]明显改善,差异有统计学意义(P＜0.05).结论内囊前肢毁损术对难治性强迫症治疗有效,术后内囊前肢纤维束存在瘢痕修复,脑代谢降低,记忆及视觉处理等认知功能改善.
목적 탐토입체정향쌍측내낭전지훼손술치료난치성강박증적료효、안전성급궤제.방법 회고성분석사천대학화서의원신경외과자2009년1월지2014년1월행입체정향쌍측내낭전지훼손술적14례난치성강박증환자적술전、술후3개월급6개월림상자료,비교수술전후자공진미산장량섬유속성상(DTT)、뇌포도당대사(PET/CT)、증상상관량표급부분인지공능량표평분적변화. 결과 술후3월DTT시내낭전지련계전액협여문상체적전후섬유속대부분훼손,이술후6월부분섬유반흔수복재생.술후6월PET/CT현시광액협피층(우:1.17±0.20,좌:1.20±0.06)、복내측액협피층(우:1.20+0.02,좌:1.18±0.07)、문상체(우:1.17±0.04,좌:1.12±0.06)、전구대회(1.06±0.06)대사교술전(우:1.41±0.19,좌:1.40±0.16;우:1.26±0.02,좌:1.23±0.08;우:1.35±0.10,좌:1.37±0.12;1.23±0.07)강저,이침협피층(우:1.58±0.14,좌:1.63±0.21)여술전(우:1.39±0.14,좌:1.41±0.15)상비대사증가,차이균유통계학의의(P＜0.05);술후6월야로-포랑강박량표평분(9.00±4.94)、한밀이돈초필량표평분(8.28±4.59)화한밀이돈억욱량표평분(6.14±2.24)분치교술전[(29.21±5.36、22.64±4.93、17.84±6.13)균명현하강,차이유통계학의의(P＜0.05);즉각/연지라집기억[(21.28±4.85)/(18.00±5.39)]、즉각/연지시각재생[(13.00±1.51)/(12.14±2.14)]급목괴도측험(39.83±6.80)교술전[(17.21±5.61)/(14.00±5.34)、(10.00±3.35)/(8.64±3.52)、(31.50±10.76)]명현개선,차이유통계학의의(P＜0.05).결론 내낭전지훼손술대난치성강박증치료유효,술후내낭전지섬유속존재반흔수복,뇌대사강저,기억급시각처리등인지공능개선.
Objective To explore the curative effect of stereotactic bilateral anterior internal capsulotomy on refiactory obsessive-compulsive disorder (OCD) and its safety and possible mechanism.Methods Retrospective analysis of clinical data of 14 patients with refractory OCD,admitted to and underwent anterior capsulotomy in our hospital from January 2009 and January 2014,was performed,including MR diffusion tensor imaging (MR-DTI),cerebral gluconate metabolism,obsessive-compulsive symptom and partial cognitive function evaluations before surgery,3 and 6 months after surgery.Results MR-DTI showed that most of anterior limb fibers between the prefrontal lobe and striatum were damaged 3 months after the surgery,however,several fibers got repair under scar formation at 6 months follow-up.The metabolism in the orbital frontal cortex (right:1.17±0.20,left:1.20±0.06),ventromedial medial frontal cortex (right:1.20±0.02,left:1.18±0.07),striatum (right:1.17±0.04,left:1.12±0.06),anterior cingnlate (1.06±0.06) 6 months after capsulotomy was significantly decreased as compared with that before surgery (right:1.41±0.19,left:l.40±0.16;right:1.26±0.02,left:1.23±0.08;right:1.35±0.10,left:1.37±0.12;1.23±0.07,P＜0.05),however,that in the occipital lobe (right:1.58±0.14,left:1.63±0.21) was significantly increased as compared with that before surgery (right:1.39±0.14,left:1.41 ±0.15,P＜ 0.05).Yale-Brown obsessive compulsive scale,Hamilton anxiety scale and Hamilton depression scale scores 6 months after the surgery (9.00±4.94,8.28±4.59 and 6.14±2.24) were significantly decreased as compared with those before surgery (29.21±5.36,22.64±4.93 and 17.84±6.13,P＜0.05),while the post-surgery immediate/delayed logical memory scores (21.28±4.85,18.00±5.39),immediate/delayed visual regeneration scores (13.00±1.51,12.14±2.14) and block design test scores (39.83±6.80) were improved significantly as compared with those before surgery (17.21±5.61,14.00±5.34;10.00±3.35,8.64±3.52;31.50±10.76,P＜0.05).Conclusion Anterior capsulotomy is an effective treatment of refiactory OCD:the fibers are partly repaired,brain metabolism is reduced and the memory and visual processing abilities are improved after surgery.