Gao Guodong, Wang Xuelian, He Shiming, Li Weixin, Wang Qingfeng, Liang Qinchuan, Zhao Yaqun, Hou Fang, Chen Ling, Li Aining
Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xian, China.
Stereotact Funct Neurosurg. 2003;81(1-4):96-104. doi: 10.1159/000075111.
The aim of this study was to explore a new way of treating drug addiction by ablating the nucleus accumbens (NAC), 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 NAC 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 NAC 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.
本研究旨在探索一种通过立体定向手术毁损与药物所致心理依赖密切相关的伏隔核（NAC），阻断中脑皮质边缘多巴胺回路，缓解对药物的渴求并降低戒毒后复发率的治疗药物成瘾的新方法。在动物实验的基础上，对28例患者实施立体定向手术，双侧毁损NAC以治疗阿片类药物依赖。特别制定了手术适应证、疗效标准、治疗过程以及手术的治疗和安全性评估指标。平均随访期为15个月。截至目前，11例未复发。其中4例患者的戒毒时间超过半年（3例超过1年），7例不足半年。15例术后复发。这些复发患者中，3例戒毒时间超过半年，10例在1个月至半年之间，2例不足1个月。7例疗效优秀（26.9%），10例良好（38.5%），2例差（7.7%）。另有7例在撰写本文时仍在观察中。术后1个月内、1个月至半年以及半年以上的复发率分别为7.7%、38.5%和57.5%。术后这些患者未出现颅内血肿或感染等手术常见并发症。2例性格类型略有改变，4例出现短暂记忆力减退，但均不影响其日常生活和学习功能，1个月内均恢复。双侧毁损NAC的立体定向手术治疗吸毒者心理依赖有不同程度疗效，未出现特殊并发症，手术安全可行。本研究平均随访时间为15个月，疗效满意，吸毒者戒毒后的复发率明显降低。
