定向伏隔核射频毁损戒毒的毁损情况与疗效关系探讨

　　【摘要】 目的 探讨定向伏隔核射频毁损术戒毒中毁损灶的位置、大小与疗效、并发症的关系。 方法 回顾性分析接受定向伏隔核射频毁损戒毒手术后随访期达1年以上的60例志愿者的病历资料，复查MRI，测量毁损灶中心平均坐标值及毁损灶的平均大小，参照Schaltenbrand-Bailey人脑标准图谱，探讨毁损灶的位置、大小与疗效、并发症的关系。 结果 失访2例 (3.3%)。疗效优27例 (45.0%)，良10例 (16.7%)，无效17例 (28.3%)，差4例 (6.7%);总有效率61.7%，复吸率35.0%。伏隔核内有效靶点的平均坐标值分布趋势：x (6.5 ± 0.5) mm，y (21.5 ± 1.0) mm，z (-8.5 ± 1.5) mm;最佳毁损灶平均大小为8 mm × 10 mm × 6 mm，占整个伏隔核体积的1/3。中远期特异并发症包括顺行性遗忘、动机形成障碍10例，性欲减退1例，情感障碍1例，冲动行为1例，嗅觉迟钝1例;发生率为23.3%。 结论 定向伏隔核射频毁损戒毒的有效靶点位于伏隔核腹内侧的壳部，疗效及中远期特异并发症与毁损灶具体位置的设定及体积大小有关。毁损灶体积过小，导致手术无效;毁损灶偏离有效靶点，或毁损体积过大，均可导致并发症的发生。

　　【关键词】 立体定位技术 伏隔核 阿片相关性障碍

　　Exploration of correlation between the therapeutic effect and stereotactic radiofrequency lesioning

　　of nucleus accumbens for drug abuse

　　WANG Xuelian, HE Shiming, HENG Lijun, et al

　　Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi an 710038, China

　　Abstract: Objective To explore the correlation of the therapeutic effect and complications with the location and volume of the lesion in stereotactic radiofrequency surgery of nucleus accumbens for drug abstinence. Methods The clinical materials of 60 volunteers of drug addict who underwent stereotactic radiofrequency lesioning of the nucleus accumbens with follow-up over 1 year were retrospectively studied. Postoperative MRI measured the average size of the lesion focus and average coordinate data of the lesion center. The relationship of the location and size of the lesion focus with the efficacy and complications was investigated according to the Schalternbrand-Bailey human brain atlas. Results Excellent therapeutic effect was achieved in 27 cases (45.0%), good in 10 (16.7%), inefficacy in 17 (28.3%), and poor in 4 (6.7%). Total effective rate was 61.7%, relapse rate was 35.0%, and 2 cases (3.3%) lost follow-up. The distribution trend of effective target coordinate value within nucleus accumbens was as follows: x was (6.5±0.5) mm, y (21.5±1.0) mm, z (-8.5±

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