联合应用多软膜下横切术治疗顽固性癫痫  

Combining application of multiple subpial transection to the treatment of intractable epilepsy

作　　者：赵全军[1] 田增民[1] 刘宗惠[1] 李士月[1] 林鸿[1] 于雪[1] 

机构地区：[1]海军总医院神经外科,北京100037

出　　处：《立体定向和功能性神经外科杂志》2004年第4期193-195,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的　多软膜下横切术 (multiplesubpialtransection ,MST)是治疗痫灶位于功能区的顽固性癫痫的一种手术方法。为证实MST的疗效 ,我们首先进行了动物实验研究 ,继而应用于临床。方法　在动物实验的基础上 ,我们自 1991年以来共实施MST 2 0 0例 ,其中单纯MST 80例 ,MST联合其它术式 12 0例 (合并使用胼胝体切开、颞叶切除、痫灶切除等 )。对手术方法还进行了一系列改良。结果　经过改良与临床应用后 ,16 0例病人随访 1～ 8年 ,癫痫发作完全控制者 10 0例 (6 2 .5 % ) ,明显减少 (75 %以上 ) 32例 ,减少 (5 0 %以上 ) 2 0例 ,无效 8例。总有效率为 95 % ,显效 82 .5 % ,所有病例均无永久性功能损害。结论　结果表明MST联合其它术式可提高手术疗效。分组结果表明 ,单纯MST组对于局限性无器质病变的病例与联合手术组同样有效。对于半球广泛性痫灶的病人 ,为避免术后严重并发症 ,应先行半球广泛MST ,仅对MST疗效不理想者行半球切除术。Objective Multiple subpial transection (MST) is one approach to the surgical treatment of intractable epilepsy with epileptogenic lesion located in functional areas.To verify the effect of MST,we performed an experimental study first,followed by clinical application.Methods On the basis of the experimental study,we performed MST in 200 intractable epileptic patients from 1991 to 2000.Of them,80 cases underwent MST only while 120 others underwent MST combined with other techniques,such as corpus callostomy,temporal lobectomy and focus resection.A series of modifications of the surgical techniques were made.Results The results of our experimental study indicated that MST could inhibit the formation and spreading of epileptic discharge and limit the damage to neurons in a minimal area on the epileptogenic agent injected cortex.MST does not impair major functions of the cortex.After the clinical application and modifications,160 patients were followed up for 1 to 8 years.Complete control of seizure was obtained in 100 cases (62.5%),significant reduction (more than 75%) in 32,reduction (more than 50%) in 20 and no change in 8.The total effective rate was 95.0%,and the significant effective rate was 82.5%.No permanent functional defects were found in any patients.Conclusion The results indicated that MST is an effective approach to the surgical treatment of intractable epilepsy.MST can be combined with other approaches.The outcome of the subdivision of the MST only group indicates that MST on local epileptogenic lesion without structural changes is as effective as that of the combined operation group.To extensive hemispheric disturbance,MST should be done first to avoid severe complications.Hemispherectomy should be performed only on poor affected cases of MST.

关 键 词：难治性癫痫 多软膜下横切术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]