立体定向手术治疗难治性精神分裂症近期疗效及远期预后分析

目的　探讨立体定向手术治疗难治性精神分裂症的近期疗效和远期预后。方法　回顾性分析 1987年 3月～ 2 0 0 4年 3月间应用立体定向多靶点毁损手术治疗的 39例精神分裂症患者 ,对术后超过 10年的 15例患者设立非手术对照组 ,采用简明精神病量表 (BPRS)、大体评定量表 (GAS)、临床疗效总评量表 (CGI)、阳性和阴性症状量表 (DANSS)、社会功能缺陷量表 (SDSS)和日常生活能力量表 (ADL)等对治疗结果和远期预后进行评定。结果　 39例手术患者优 3例 ,显著进步 16例 ,进步 14例 ,无效 4例。手术前后GAS、BPRS、CGI评分有显著性差异(P <0 .0 1)。长期随访 ,手术组与非手术组BPRS中的激活因子分、PANSS中的攻击危险性和偏执 /好斗因子分有显著性差异 (P <0 .0 1) ,余各项评分及SDSS和ADL评分两组间的差异无显著性 (P >0 .0 5 )。结论　立体定向手术是治疗难治性精神分裂症的安全、有效的方法 ,手术对患者的社会和生活能力无明显影响。

Postoperative result and long-term outcome of stereotactic surgery for intractable schizophrenia

Objective To explore the postoperative result and long-term outcome of stereotactic surgery for intractable schizophrenia.Methods 39 cases of intractable schizophrenia operated by stereotactic multiple target radiofrequsency lesion were analyzed retrospectively.15 cases which operated over 10 years were re-assessed with the same matched patients without psychosurgery as controls.All patients were assessed with scales for clinical symptoms (global assessment scale,GAS;clinical global impression,CGI;brief psychiatric rating scale,BPRS;postive and negative,symptom scale,PANSS) and Social functions (social disability screening schedule,SDSS,activity of daily living scale,ADS).Results Postoperative results showed cure in 3,obviously improved in 18,improved in 14,and no change in 4,GAS,BPRS were obvious statistical significant relationship between pre- and post- operation.Long-term follow-up showed that the patients with surgery had lower scores of RANSS subscales of aggressive and paranoid / pugnacity,and higher scores of BPRS activity than patients with no operation.There were no significant differences of SDSS and ADL Scores between both the groups.Conclusion The present study suggests that the stereotactic surgery is safety and effective therapy for intractable schizophrenia,and psychosurgery has no obvious effects daily living and social function.