难治性癫痫手术效果评判时限  

THE CRITICAL TIME FOR JUDGING SURGICAL EFEECTS OF EPILEPSY SURGERY

作　　者：万衡[1] 刘力克[1] 胡柠杉[1] 马骁[1] 雷町[2] 周泽永[2] 邝璞[2] 

机构地区：[1]四川大学华西第四医院,成都610041 [2]四川大学华西医院

出　　处：《现代预防医学》2007年第17期3382-3383,3385,共3页Modern Preventive Medicine

摘　　要：[目的]总结分析难治性癫痫手术效果以及手术后效果趋于稳定的时限。[方法]对难治性癫痫手术患者进行长期追踪随访,并依照Engel分级对患者术后效果进行分类;比较患者术后半年、1年和远期(≥1.5年)疗效,观察术后达到EngelⅠ～Ⅱ疗效比例的变化。[结果]120例难治性癫痫手术患者中,术后半年随访发现:60.8%术后无癫痫再发,5.8%术后仅有先兆发作,12.5%偶有痫性发作,9.2%痫性发作明显减少,11.7%手术效果不明显;术后1年随访发现:53.3%无癫痫再发,4.2%术后仅有先兆,11.7%术后偶有痫性发作,20.0%痫性发作明显减少,10.8%手术效果不明显。最近的随访结果如下(随访1.5～3年,平均1.8年):51.7%无癫痫再发,3.3%仅有先兆,10.8%术后偶有痫性发作,23.3%痫性发作明显减少,10.8%手术效果不明显。半年期随访预后和一年期随访预后中达到EngelⅠ～Ⅱ的比例差异有统计学意义(P≤0.05);一年期随访预后与长期随访预后中达到EngelⅠ～Ⅱ比例的差异无统计学意义(P≥0.05)。[结论]药物难治性癫痫术后半年期随访评判疗效不可靠,而1年期疗效可预示术后长期效果。[Objective] To analyze the long-term results of refractory temporal lobe epilepsy surgery, and to evaluate the critical time for judging the outcomes. [Methods] Longitudinal follow up of 120 temporal lobe epilepsy patients undergone operation were carried out, the surgical effect was sorted according to Engel classification, and the postoperative effects of half one year, one year after operation and the prostecdtive efficacy （ ≥ 1.5 years）, the changes of proportions of Engel Ⅰ- Ⅱ outcomes were observed. [Results] Of the 120 postoperative patients, the results of half one year follow up showed that 60.8% were seizure-free, 5.8% had only postoperative aurae seizure, 12.5% had rare seizures （less than 2 times）, and 9.2% benefited from the operation （more than 80% seizures been controlled）, 11.7% had unsatisfactory outcomes （ less than 20% seizure been controlled）. The results of one year follow up showed that 53.3% became seizure-free, 4.2% had only postoperative seizure, 11.7% had rare seizures （less than 3 times）, and 20.0% benefited from the operation, 10.8% had unsatisfactory outcomes. And the results of long-term follow up for 1.5-3 years （the mean was 1.8 years） showed that 51.7% became seizurefree, 3.3% had only postoperative auras seizures, 10.8% had rare seizures, 23.3% benefited from the operation, and 10.8% had unsatisfactory outcomes. The ratio of Engel Ⅰ- Ⅱ outcomes in half an year follow up was significantly different front that in one year follow up （P 〈 0.05）, the ratio of Engel Ⅰ- Ⅱ outcomes in one year follow up had no obvious difference from that in lougterm follow up （P〉 0.05）. [Conclusions] It is unreliable to judge postoperative effects with the results of half one year follow up. But the therapeutic effect of one year follow up can predict the long-term outcomes.

关 键 词：难治性癫痫 手术 评估 

分 类 号：R742.1[医药卫生—神经病学与精神病学]