Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery
Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery
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DOI：
10.1159/000075111
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发表时间：
2003-01-01
影响因子：
1.7
通讯作者：
Li, AN
中科院分区：
文献类型：
--
作者：
Gao, GD;Wang, XL;Li, AN
本研究旨在通过立体定向手术切除与药物心理依赖密切相关的伏隔核（NA(C)），阻断中脑皮质边缘多巴胺回路，减轻对药物的渴望，降低戒毒后的复发率，探索治疗药物成瘾的新途径。在动物实验的基础上，对28例患者行立体定向手术，在NA(C)双侧做一个病灶，治疗阿片类药物依赖。重点阐述了手术适应证、疗效标准、治疗过程及疗效和安全性评价指标。平均随访时间为15个月。11例无复发。4例患者无药时间在半年以上（3例在一年以上），7例在半年以下。术后复发15例。无药时间半年以上3例，1个月~半年10例，1个月以下2例。疗效优7例（26.9%），良10例（38.5%），差2例（7.7%）。在撰写本文时，另有7起案件仍在调查中。术后1个月内、1个月~半年、半年以上复发率分别为7.7、38.5%、57.5%。术后无颅内血肿、感染等常见手术并发症。2例出现轻度性格改变，4例出现暂时性记忆丧失，但未影响日常生活和学习功能。他们都在1个月内康复。立体定向手术双侧NA(C)病变治疗吸毒成瘾者心理依赖有不同程度的疗效。无特别并发症发生。操作安全可行。本研究的平均随访时间为15个月。效果令人满意。吸毒人员戒毒后复发率明显降低。版权所有(C) 2003 S. Karger AG，巴塞尔。
The aim of this study was to explore a new way of treating drug addiction by ablating the nucleus accumbens (NA(C)), which has a close relationship with drug-induced psychological dependence, using stereotactic surgery, blocking the mesocorticolimbic dopamine circuit, alleviating craving for drugs and lowering the relapse rate after detoxification. On the basis of animal experiments, stereotactic surgery was performed in 28 patients by making a lesion in the NA(C) bilaterally to treat opiate drug dependence. Indications, the criterion of therapeutic effect, treatment process and the therapeutic and safety evaluation index of the surgery were formulated particularly. The mean follow-up period was 15 months. Relapse has not occurred in 11 cases up till now. Drug-free time in these patients has been more than half a year in 4 cases (more than a year in 3 cases), and less than half a year in 7 cases. Relapse occurred in 15 cases after surgery. Drug-free time in these patients was more than half a year in 3 cases, between 1 month and half a year in 10 cases and less than 1 month in 2 cases. The therapeutic effect was excellent in 7 cases (26.9%), good in 10 cases (38.5%) and poor in 2 cases (7.7%). Another 7 cases were still under investigation at the time of writing. Relapse rates after surgery were 7.7, 38.5 and 57.5% within 1 month, between 1 month and half a year and after more than half a year, respectively. There were no common complications of surgery such as intracranial hematoma or infection in these patients after operation. Character type was changed slightly in 2 cases, and 4 cases suffered temporary memory loss, which did not affect their daily lives and learning function. They all recovered within 1 month. There were different degrees of effectiveness of treating drug addicts' psychological dependence by making lesions in the NA(C) bilaterally with stereotactic surgery. No particular complications occurred. The operation is safe and feasible. The mean follow-up time in this study was 15 months. The effectiveness was satisfactory. The relapse rate of drug addicts after detoxification was clearly reduced. Copyright (C) 2003 S. Karger AG, Basel.