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立体定向毁损术治疗精神发育迟滞伴行为障碍的长期疗效观察
张晓华,李建宇,张宇清,王刚,李玉辉,雷国亮,张成贵,赵开,李东升,李勇杰
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摘要:
目的 探讨立体定向杏仁核联合内囊前肢毁损治疗精神发育迟滞( Mental Retardation,MR)伴有的行为障碍(冲动、攻击、自伤、毁物)的临床长期疗效和安全性.方法 2007年9月~2009年6月收治的33例MR伴冲动、攻击、自伤、毁物行为障碍患者,均符合ICD-10和DSM-Ⅳ的诊断标准.治疗靶点选择内囊前肢和杏仁核,采用可视靶点CT定位.全麻下头皮切口,钻孔切开硬脑膜,直径2.0 mm毁损电极穿刺,毁损前行宏刺激确定非功能区后,进行毁损灶的制作,参数80℃、60 s.术前、术后6、12、24个月由精神科医师应用临床总评量表(CGI)和儿童攻击行为量表(CAS- P)对治疗效果进行评定,采用韦氏智力量表(WIS)评定智商.结果 (1)术后24个月CGI量表评定结果显示,33例患者总有效率为91.5%,其中优5例(15.1%),显著进步16例(57.6%),进步9例(21.2%),无变化3例(6.1%);(2)术前CAS-P评分平均为(67.00±10.95)分,术后6个月为(15.20±1.62)分,24个月后为(16.30±1.64)分,与术前比较差异均有统计学意义(P<0.01);(3)术前WIS评分为(35.88±14.60)分,术后24个月为(36.24±12.35)分,虽有所提高,但差异无统计学意义;(4)安全性评估:脑内血肿1例,经治疗完全康复;偏瘫1例经康复治疗明显好转;术后高热3例;性欲亢进2例;食欲亢进2例,经治疗均于2周内恢复.结论 立体定向杏仁核联合内囊前肢毁损术治疗MR伴有的行为障碍(冲动、攻击、自伤和毁物)安全、有效,长期疗效稳定.
关键词:  精神发育迟滞  行为障碍  杏仁核  立体定位技术  内囊前肢  射频毁损
DOI:
基金项目:
Long term outcome after stereotactic nenrosurgery for aggessive behavior of Mental Retardation
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Abstract:
Objective To evaluate the efficacy and safety of radiofrequency coagulation in bilateral amygdale and anterior limb of internal capsule as a treatment for mental retardation accompanying with aggressive and impulsion behaviors. Methods 33 patients, all met diagnostic criteria of ICD- 10 and DSM-Ⅳ,were treated with bilateral anygdaloid body and anterior limb of internal capsule radiofrequency coagulation. All patients referred to surgery were previously failed to response to multiple non--surgical methods. All targets were viewable and located directly by CT. After surgery, the symptomatic improvements were evaluated by Clinical global impression (CGI) and Children aggressive scale--parent (CAS--P), and intelligence quotient (IQ) was assessed with Wechsler intelligence scale (WIS). Results The total efficiency was 91.5% at 24 month follow--up (excellent for 5 cases,significant improved for 16 cases, improved for 9 cases and no change 3 for cases)with CGI evaluation. Postoperative scores of CAS--P were significant decreased from 67 to 15.2 at 6 month follow--up,and 16 at 24 month follow--up. The IQ average score was improved slightly from 35.88 to 36.24. One patient had a small intracerebral hematoma,and complete rehabilitated two weeks later. One patient experienced a hemiplegia and improved two weeks later. Transient complications include hyperpyrexia (3 cases),hypersexuality (2 cases) and hyperorexia(2 cases) ,and recovered within two weeks. Conclusions Bilateral amygdaloid body and anterior limb of internal capsule stereotactic radiofrequency coagulation is proven a safe and effective for MR accompanying with aggressive and impulsion behavior,it provide a significant short and long term effect, without severe or permanent complications.
Key words:  Mental retardation  Conduct disorder  Amygala  Stereotaxic techniques  Anterior limb of internal capsule  Radiofrequency coagulation

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