本文關(guān)鍵詞： 神經(jīng)性厭食癥 手術(shù)治療 腦深部電刺激 內(nèi)囊前肢毀損　出處：《山東大學(xué)》2012年博士論文　論文類型：學(xué)位論文

【摘要】：背景和目的： 神經(jīng)性厭食癥是一種進食障礙,其特征是由于進食明顯減少所致體重明顯減輕、閉經(jīng),通常伴有體像障礙、強迫癥狀等其它精神障礙。隨著病情進展,患者可出現(xiàn)陣發(fā)性暴食與暴食后嘔吐癥狀。傳統(tǒng)的神經(jīng)性厭食癥的治療方法主要有心理治療和藥物治療,往往對早期患者有一定療效,但大多數(shù)患者經(jīng)歷長期的心理、藥物治療無明顯效果,成為難治性神經(jīng)性厭食癥。難治性神經(jīng)性厭食癥具有較高的死亡率,常死于嚴(yán)重營養(yǎng)不良、電解質(zhì)紊亂、多器官衰竭等并發(fā)癥。近年來腦立體定向手術(shù)用于治療難治性強迫癥,具有安全、微創(chuàng)、副作用少的特點,顯著改善率在90%以上。由于神經(jīng)性厭食癥與強迫癥都屬于強迫譜系障礙,臨床上具有許多共同特點,因此從2006年以來,我們采用手術(shù)方法治療難治性神經(jīng)性厭食癥患者,即心理、藥物治療無效的嚴(yán)重患者。 在長期的手術(shù)治療中我們發(fā)現(xiàn),由于病程長短、臨床癥狀嚴(yán)重程度對于手術(shù)方法的選擇及治療預(yù)后及起了關(guān)鍵作用,因此我們依據(jù)患者的不同臨床特征進行臨床分級研究(Ⅰ-Ⅳ級),期望該臨床分級可以在手術(shù)時機的判斷、手術(shù)方式的選擇及預(yù)后判斷有所幫助。 方法： 在所有接受手術(shù)治療的104例神經(jīng)性厭食癥患者中隨訪到術(shù)后6個月以上的61例患者,將這61例患者手術(shù)前后主要癥狀、病程、體重身高指數(shù)、月經(jīng)是否正常、是否伴人格改變及日常生活能力量表(ADL量表)、簡明智力量表、Yale-Brown強迫癥量表(Y-Bocs量表),漢密頓焦慮量表(HAMA量表),漢密頓抑郁量表(HAMD量表)等指標(biāo)進行對照研究,依據(jù)術(shù)前臨床癥狀進行分級,根據(jù)不同分級選擇不同手術(shù)方式,如立體定向下雙側(cè)伏隔核電刺激術(shù)或立體定向下雙側(cè)內(nèi)囊前肢毀損術(shù),隨訪時間6-64個月,平均(26.15±10.47)個月。 結(jié)果： 大部分患者術(shù)后神經(jīng)性厭食癥癥狀明顯緩解,其中有2例于術(shù)后6個月、10個月復(fù)發(fā),再次行立體定向下雙側(cè)內(nèi)囊前肢毀損術(shù),癥狀有明顯改善,至隨訪時病情穩(wěn)定。1例Ⅳ級患者術(shù)后癥狀無改善,于術(shù)后18個月自殺死亡。其余所有患者至隨訪時,體重身高指數(shù)大于17.5者占85.37%,其中Ⅱ、Ⅲ級患者均恢復(fù)正常；30例術(shù)前閉經(jīng)者術(shù)后恢復(fù)正常,7例由不規(guī)律轉(zhuǎn)為規(guī)律,其中Ⅱ、Ⅲ級患者均治愈,Ⅳ級患者中有83.87%治愈；手術(shù)前后除簡明智力量表無明顯統(tǒng)計學(xué)意義,其余4項量表評分顯示手術(shù)前后有顯著差異,Ⅱ、Ⅲ級患者改善程度為明顯有效或有效,Ⅳ級患者分別出現(xiàn)明顯有效、有效、改善甚至無效。其中對強迫癥狀緩解程度最佳,焦慮癥狀其次,抑郁癥狀最差；手術(shù)前后體像障礙變化有統(tǒng)計學(xué)意義,術(shù)后對肥胖恐懼者遠少于術(shù)前,術(shù)前休學(xué)或不能工作的患者術(shù)后恢復(fù)學(xué)習(xí)和工作,有明顯統(tǒng)計學(xué)差異。 結(jié)論： 通過對神經(jīng)厭食癥分級可以根據(jù)疾病嚴(yán)重程度實施相應(yīng)的治療方案,選擇適當(dāng)?shù)氖中g(shù)方式,有利于提高患者術(shù)后的療效及預(yù)后判斷,對術(shù)后患者的后續(xù)治療有指導(dǎo)意義；手術(shù)對神經(jīng)性厭食癥患者的體重改善療效顯著,改善率達到90.24%,t統(tǒng)計檢驗表明手術(shù)后體重身高指數(shù)(BMI值)增高達到極顯著水平(t=9.32.P0.0001)；手術(shù)對神經(jīng)厭食癥患者的月經(jīng)具有顯著的治愈和改善效果(Wilcoxon符號秩和檢驗,統(tǒng)計量為S,得S=297.5,P0.01)；手術(shù)對神經(jīng)性厭食癥患者的精神科量表相關(guān)指標(biāo)改善明顯,Y-BOCS量表, HAMA量表,HAMD量表評分手術(shù)前后t檢驗有明顯統(tǒng)計學(xué)意義,總有效率(顯效+有效+改善)分別為82.94%,85.37%,90.25%。t統(tǒng)計檢驗表明手術(shù)前后各項指標(biāo)差異均達到極顯著水平。
[Abstract]:Background and purpose:
Anorexia nervosa is an eating disorder characterized by eating significantly reduced due to significant weight loss, amenorrhea, often with body dysmorphic disorder, obsessive-compulsive symptoms and other mental disorders. With the progression of the disease, can occur in patients with paroxysmal vomiting symptoms. After eating and eating the main treatment of anorexia nervosa is traditional psychological therapy and drug treatment, often has certain curative effect on patients with early, but most patients experienced long-term psychological and drug treatment has no obvious effect, become refractory anorexia nervosa. Refractory anorexia nervosa has high mortality and often died of severe malnutrition, electrolyte disorders, complications of multiple organ failure in recent years the stereotactic surgery for the treatment of refractory obsessive-compulsive disorder, is a safe, minimally invasive, few side effects, significantly improve the rate of more than 90%. Because of anorexia nervosa and compulsive Symptoms are all forced spectrum disorders. There are many common characteristics in clinical practice. Therefore, since 2006, we have adopted surgical methods to treat patients with refractory anorexia nervosa, that is, mental and drug treatment ineffective patients.
In the long-term surgical treatment we found that due to the course of disease, the severity of clinical symptoms and treatment outcomes for select surgical methods and play a key role, so we according to different clinical characteristics of patients with clinical classification (I - IV), expect the clinical grading of the surgical timing and judgment, choice prognosis of surgical help.
Method錛，

本文編號：1497528