伏核手术治疗药物心理依赖的并发症分析

目的分析立体定向双侧伏核毁损术后并发症的神经解剖基础,提出预防和治疗方案。方法随访术后反馈存在并发症的近期药物依赖患者16例,部分患者复查CT或MRI,结合SchalternbrandBailey人脑图谱对靶点位置、毁损灶体积等与并发症的关系进行分析。结果本组16例中,顺行性遗忘、动机形成障碍10例,性欲减退2例,可能与毁损体积过大有关;情感障碍2例、冲动行为1例,与毁损灶过低,影响前额叶底部皮质对认知、行为的调控有关;嗅觉迟钝1例,与嗅皮质损伤有关。结论并发症与靶点定位、毁损灶体积有关。通过精确定位、毁损参数控制可以达到减少并发症的目的。

Complication analysis of nucleus accumbens lesion for treatment of drug psychological dependence

Objective To analyze the neuroanatomical basis of complications after ablating the nucleus accumbens bilaterally by stereotactic surgery and to bring forward the strategy for prevention and treatment. Methods 16 patients addicted to drugs who had fed back that they were suffering from complications post operation were followed up, and part of them received CT or MRI inspection. The relationship between the location of target,the volume of lesion focus and the complications was analyzed consulting to the Schalternbrand-Bailey human brain atlas. Results Among the group of 16 patients, anterograde amnesia, motivation-forming dysfunction 10 cases, lack of sexual craving 2 case, possibly related to the overlarge lesion volume; Dysfunction of emotion 2 cases, impulsive behavior 1 cases, possibly because the focus was so low as to influence the control of cognition and behavior by the prefrontal cortex; Insensitivity of olfaction 1 case,related to the injury of olfactory cortex. Conclusion The complications are associated with the location of target and the immoderate volume of the lesion focus. The reduction of complications can be achieved through locating the target precisely and controlling the lesion parameters suitably.