难治性癫痫手术预后因素分析  

Factors influencing postoperative prognosis of patients with intractable epilepsy

作　　者：张冉[1] 张新伟[1] 徐如祥[1] 周谷兰[1] 黄伟[1] 马宏伟[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广州510282

出　　处：《中华神经医学杂志》2007年第4期381-385,共5页Chinese Journal of Neuromedicine

基　　金：军队"十五"重大临床技术研究项目(2002卫医字18号-15);广东省卫生厅医学科学基金(A2002413)

摘　　要：目的探讨性别、诱因、发作类型、是否存在先兆、致痫灶部位、致痫灶范围、好发时段、年龄、初次发病年龄、病程、发作持续时间、发作频率、总手术时间、颅内手术时间、术中失血量等15种因素与难治性癫痫患者手术治疗后癫痫发作控制情况的关系。方法分析359例难治性癫痫患者的临床资料、手术方案和术后随访资料。结果本组所有病例随访1年以上,术后效果满意率为94.15%。单因素分析提示:诱因、发作类型、是否存在先兆、致痫灶部位、致痫灶范围、好发时段、初次发病年龄、病程、发作频率等因素与术后效果有显著性关系,性别、年龄、发作持续时间、总手术时间、颅内手术时间、术中失血量等因素与术后效果无显著性关系。Logistic回归分析发现:有诱因、全身性发作、睡眠中好发、初次发病年龄轻、病程长可能为术后癫痫控制效果不满意的独立危险因素。结论手术治疗难治性癫痫多可获得满意的效果。无发作诱因、部分性发作、无先兆、颞叶癫痫、单脑叶癫痫患者手术效果更好,睡眠中多发作、初次发病年龄轻、病程长、发作频率高者手术效果相对不满意。颞叶癫痫、单脑叶癫痫、儿童癫痫应成为外科治疗的重点。所有难治性癫痫一旦诊断成立、定位明确、可以手术,皆宜及早手术治疗。Objective To approach the relationships of the postoperative epileptic attack control with the factors including sex, inducement, type of seizure, presymptom, position of epileptic focus, extent of epileptic focus, common time and age for attack, first seizure age, course ofdiseaso, persistence time of seizure, seizure frequency, total operation time, intracranial operation time, volume of blood loss. Methods The clinical data, the operation programs and the follow-up information of 359 epileptics were analyzed retrospectively. Results The follow-up of over I year postoporatively revealed the satisfactory rate of 94.15% in the 359 casos. By single factor analysis, outcome was significantly associated with inducement, type of seizure, presymptom, position of epileptic focus, extent of epileptic focus, predilection time for attack, first seizure age, course of diseaso, seizure frequency. On the other hand, no significant differenccs were found regarding sex, age, persistence time of seizure, total operation time, intracranial operation time and volume of blood loss. By multivariate logistic regression analysis, inducement, generalized seizures, seizure in sleep, younger first seizure age, longer course of disease wcrc independent risk factors for poor control of post-oporativc epileptic seizure. Conclusion For a intractable epileptic, favorable outcome can bc obtained by surgery. The epileptics with no inducement, partial seizures, no prcsymptom, temporal lobe epilepsy, singic lobe epilepsy arc usually able to obtain more favorable outcome. The ones with seizures most in sleep, younger first seizure age, longer course of disease, higher seizure frequency usually obtain unfavorable outcome. The temporal lobe epilepsy, single lobe epilepsy, children epilepsy should need more attention in surgery and all intractable epileptics should accept the surgery treatment in time.

关 键 词：难治性癫痫 预后 癫痫发作 

分 类 号：R742.1[医药卫生—神经病学与精神病学]