摘要
目的探讨立体定向毁损术治疗海洛因依赖的手术方法并评估其手术疗效。方法应用PET、fMRI和多排螺旋CT及手术计划系统进行靶点定位,对158例海洛因依赖者多个成瘾相关脑区进行三种不同靶点组合的定向毁损术,术后随访6-12个月,评价手术疗效。结果术前脑PET、fMRI异常分别为145例和141例。全部病例手术顺利,术中无死亡。术后近期共有47例(29.7%)发生不同程度手术并发症和副作用,其中嗅觉或味觉减退21例,性格改变10例,短时记忆减退17例,智力下降7例,脑缺血脑梗死致偏瘫3例,其中2例合并大小便失禁,并发颅内出血及血肿2例,伤口感染2例。随访6-12个月,108例(68.4%)获较完整资料,手术疗效优52例(48.1%),良19例(17.6%),差35例(32.4%),死亡2例(1.9%);共29例(26.9%)存在手术并发症和副作用。病例手术前后神经心理评估比较无统计学意义(P>0.05),但与正常人比较具有统计学意义(P<0.05),复吸病例与正常人和未发生复吸病例比较也有统计学意义(P<0.05)。不同手术组间手术并发症和副作用发生率及复吸率无差异,但手术并发症和副作用的类型与手术方式有关。结论海洛因依赖者存在脑功能异常区及异常精神心理行为。定向毁损术治疗海洛因依赖近期安全有效,无严重并发症,复吸率较低。发生复吸与患者精神心理因素和特定环境等有关。
Objective To investigate the stereotactic surgery for heroin dependence and assess its effects. Methods 158 patients with heroin dependence who were divided into three groups were performed stereotactic surgery of different targets which were located by PET （positron emission tomography） , MRI （functional magnetic resonance imaging） , MSCT （multi-spiral CT） and the planned operative system from May to October in 2004. 6-12 months follows-up were carried out to assess the specific effect and side effect of the surgical procedure. Results Before the operation, there were abnormal brain areas in 145 and 141 cases of PET and fMRI, respectively. All the operations were successful without death during the operation. In the short postoperative period, complications and side effects occurred in 47 cases （29.7%） . Among them, there were 21 cases of hyposmia and hypogeusia, 10 of character changes, 17 of impermanent hypomnesia, 7 of IQ descent, 2 of complicating intracranial hemorrhage and hematoma, 2 of wound infection and 3 of hemiplegia caused by cerebral ischemia and infarction including 2 cases of combined incontinence of feces and urine. During postoperative 6-12 months＇ follows-up, 108 cases were obtained the comparatively complete data. The therapeutic effect was excellent in 52 cases （48.1%） , good in 19 （17.6%） , poor in 35 （32.4%） and death in 2 cases （1.9%） . Among them there were 29 cases （26.9%） existing operative complications and side effects. The data of physical and mental measuring scaleassessing had no significant difference between pre-and post-operation （P 〉 0.05） , while comparing with that of healthy controls there was significant difference （P 〈 0.05） . The same result were obtained between patients with relapse and patients with no relapse as well as healthy controls. For different groups, there was no significant difference in the incidence of complication and relapse, while the type of the complication or side effect was related to the methods adopted in the operation. Conclusios There exist in the brain of most heroin addicts abnormal areas and abnormal physical and mental behaviors. The stereotactic surgery for heroin dependence is safe and effective without causing serious postoperative complications. The relapse rate is low. Relapse has some relationship with the psychological characters of the patients and the particular circumstances.
出处
《中华神经外科杂志》
CSCD
北大核心
2005年第10期594-599,共6页
Chinese Journal of Neurosurgery
