儿童癫痫的手术治疗  

Surgical correction of intractable epilepsy in children

作　　者：梁树立[1] 李安民[1] 傅相平[1] 张志文[1] 耿锋[1] 

机构地区：[1]中国人民解放军三四医院神经外科,北京100037

出　　处：《中华小儿外科杂志》2004年第4期325-327,共3页Chinese Journal of Pediatric Surgery

摘　　要：目的　总结分析儿童期顽固性癫痫手术治疗效果和经验。方法　回顾性分析 2 0 0 1年7月～ 2 0 0 2年 11月在我科接受手术治疗的 2 5例 14岁以下的顽固性癫痫病例 ,统计患儿的发病、检查及手术治疗情况 ,手术方式的选择应依据患儿术前脑电图与术中脑电图的定位情况而进行。结果本组 2 5例患儿 ,年龄 3～ 14岁 ,病程平均 5 .3年 ,影像学异常 9例 ,占 36 .0 % (9/ 2 5 ) ,智商明确缺陷 12例 ,占 4 8.0 % (12 / 2 5 ) ,以强直 痉挛性发作为主 16例 ,占 6 4 .0 % (16 / 2 5 )。病灶位于额叶 10例 ,占4 0 .0 % (10 / 2 5 ) ,颞叶 6例 ,占 2 4 .0 % (6 / 2 5 ) ,额颞叶 5例 ,占 2 0 .0 % (5 / 2 5 ) ,顶叶和枕叶各 2例 ,占8.0 % (2 / 2 5 )。手术行病灶切除及前颞叶切除 11例 ,占 4 4 .0 % (11/ 2 5 ) ,选择性海马 杏仁核切除 4例 ,占 16 .0 % (4 / 2 5 ) ,胼胝体切开 15例 ,占 6 0 .0 % (15 / 2 5 ) ,单纯多处软膜下横切 2例 ,占 8.0 % (2 /2 5 )。术后出现一过性对侧轻瘫 4例 ,一过性语言不利 2例。术后疗效满意 2 3例占 92 .0 % (2 3/ 2 5 ) ,显著改善 1例占 4 .0 % (1/ 2 5 ) ,良好 1例占 4 .0 % (1/ 2 5 )。结论　合理的选择手术方式 ,对儿童期顽固性癫痫手术治疗 ,手术效果良好 。Objective To analyze operative outcomes of children with intractable epilepsy. Methods Twenty five children with intractable epilepsy who underwent surgical intervention were reviewed.Results The children were between 3～14 years of ages. The average duration of epilepsy was 5.3 years. 9 children (36%)had abnormal MRI, 12 (48%) had low IQ and 16 (64%) had general tonic clonic seizures. Epileptogenic foci were located in the frontal lobe in 10 cases, temporal lobe in 6, fronto temporal lobe in 5, occipital lobe in 2 and parietal lobe 2 cases. Eleven patients (44%) underwent lesion resection or anterior temporal lobectomy, 4 (16%) underwent selective amygdalohippocampotomy, 15 (60%) had corpus callosotomy and 2 multiple subpial transection (MST) only. The complications included 4 transient paresis and 2 transient slurred speech. 23 patients (92%) had satisfactory results whereas 1 (4%) had noticeable improvements.Conclusions Good surgical results can be achieved in children with intractable epilepsy with few complication.

关 键 词：儿童 癫痫 手术治疗 神经外科 

分 类 号：R726.5[医药卫生—儿科]