前颞叶切除术对癫痫患者记忆功能影响的临床研究  

A clinical study on pre- to postoperative memory change of patients with temporal lobe epilepsy

作　　者：遇涛[1] 李勇杰[1] 张国君[1] 王玉平[2] 蔡立新[1] 宋蕾[2] 杜薇[1] 

机构地区：[1]首都医科大学宣武医院,北京功能神经外科研究所,北京100053 [2]首都医科大学宣武医院神经内科,北京100053

出　　处：《中华神经外科杂志》2007年第10期726-729,共4页Chinese Journal of Neurosurgery

基　　金：北京市自然科学基金资助项目(重点项目)(3051001)

摘　　要：目的评估前颞叶切除术对癫痫患者记忆功能的影响。方法对30例颞叶癫痫病例往术前、术后2周和术后6个月以上时分别进行记忆测评,比较患者记忆评分的变化;对24例患者进行1H-MRS成像,评估1H-MRS值与韦氏记忆评分之间的相关关系。结果术前MQ均值与术后2周时有显著性差异,术后6个月以上较术后2周时有显著改善;短时记忆在术前、术后无明显变化;非海马硬化组中患侧NAA/Cr与术前、术后短时记忆差值有相关性,患侧NAA/(Cr+Cho)以及健侧与患侧NAA/(Cr+Cho)之差与术前、术后MQ差值有相关性。结论术后早期多数患者MQ、长时记忆、瞬时记忆有较明显下降,6个月以后有明显恢复,而短时记忆下降不明显。患侧海马1H-MRS值与术前、术后韦氏记忆评分之间存在一定的相关关系。Objective To evaluate memory change after anterior temporal lobectomy （ATL）for patients with temporal lobe epilepsy （TLE）. Methords Objective memory （Wechsler Memory ScaleRevised, WMS-R） was individually examined for 30 patients with TLE one week before and two weeks or six months after operation. Memory change was compared fully among groups. 1↑H-magnetic resonance spectroscopy（1H-MRS） ratio was examined in 23 patients and the correlation between memory change and 1↑H-MRS ratio was primarily analysised. Results The mean score of MQ decreased significantly from 90.6 ±21.4 before surgery to 81.0 ±22. 6 after surgery in 30 patients （P 〈 0. 01 ） , while increased significantly when tested again 6 months after surgery. The change pattern was the same when the long-term and instantaneous-term score was evaluated, while the change of short-term score was not significant. The NAA/（ Cr ＋ Cho） ratio of memory unchanged group is significantly lower than that of the controlled group （ P 〈 0.05 ）. Short-term memory score almost had significant difference between the group with and without hippocampal sclerosis. In nonhippocampal sclerosis group, significant correlation between the NAA/Cr ratio and the difference of short-term score before and after surgery was revealed; And the NAA/（ Cr ＋ Cho）ratio in the focus side also had correlation to the difference of MQ before and after surgery; The NAA/（ Cr ＋ Cho） ratio difference between ipsilateral and contralateral also showed correlation with the difference of MQ before and after surgery. Condusion Most patients＇ memory scores except for short-term score decreased obviously short time after surgery, and come back to about previous level in the following 6 months. Some significant correlation is revealed between the 1↑H-MRS values and the memory score.

关 键 词：颞叶癫痫 前颞叶切除术 记忆 磁共振波谱 

分 类 号：R742.1[医药卫生—神经病学与精神病学]