不伴癫痫发作的幕上占位病变患者的皮层脑电图特征与术后癫痫的研究  

Characteristics of electrocorticography in patients with supratentorium-occupying lesion but no epileptic seizures and postoperative epilepsy

作　　者：但炜[1] 薛晓辉[2] 唐文渊[1] 漆新伟[1] 刘福英[1] 

机构地区：[1]重庆医科大学附属第一医院神经外科,重庆400016 [2]成都军区昆明疗养院478疗区内科脑电图室,昆明650200

出　　处：《第三军医大学学报》2010年第3期285-287,共3页Journal of Third Military Medical University

基　　金：重庆市卫生局资助面上项目(05-2-167)~~

摘　　要：目的探讨不伴癫痫发作的幕上占位病变患者的皮层脑电图(electrocorticography,ECoG)特点及皮层横纤维热凝术对术后癫痫的作用。方法选择76例术前无癫痫发作的幕上占位病变患者,术中行ECoG监护及病灶切除加周围痫灶皮层热凝(监护组)。100例同期无癫痫发作幕上占位病变患者仅单纯病灶切除(对照组),术后随访24～48个月,平均33.6个月,比较两组术后癫痫发生率的差异。结果①监护组76例病灶切除前ECoG显示有痫性放电65例(85.52%)。其中41例行皮层热凝,痫性放电减少或消失。②术后早期癫痫:监护组10例(13.16%),对照组28例(28.00%),两组结果差异显著(χ2=5.78,P<0.05)。术后晚期癫痫发生率:监护组与对照组分别为11.84%和27.70%,差异显著(χ2=6.34,P<0.05)。结论术前无癫痫发作的幕上占位病变患者,ECoG显示痫性放电阳性率较高;病灶切除联合皮层热凝痫性放电较单纯病灶切除术后癫痫发生率低。Objective To study the characteristics of electrocorticography （ECOG） in patients with supratentorium-occupying lesion but no epileptic seizures and the effects of heat coagulation of cortical transverse fibers on postoperative epilepsy. Methods Patients with supratentorium-occupying lesion but no preoperative epileptic seizures were divided into treatment group （ n = 76） and control group （ n = 100）. Patients in treatment group underwent resection of the lesion and heat coagulation of its surrounding tissues during which ECOG was performed to monitor their conditions. Patients in control group underwent simple resection of the lesion without heat coagulation of its surrounding tissues. The patients were followed up for 24 -48 months （mean 33.6 months） after operation to compare the incidence of epilepsy between the two groups. Results ECOG displayed epileptic discharge in 65 patients （85.52%） of the treatment group. After heat coagulation, epileptic discharge decreased or disappeared in 41 out of the 65 patients with epileptic discharge. Early postoperative epilepsy occurred in 10 （ 13.5% ） and 28 （28.00%） patients of the treatment and control groups, respectively （ Chisquare = 5.78,P 〈 0.05）. Late postoperative epilepsy occurred in 11.84% and 27.70% of patients in the two groups, respectively （Chisquare =6.34,P 〈0.05）. Conclusion The positive discharge rate is rather high in patients with supratentorium-occupying lesion but no preoperative epileptic seizures. The incidence of epilepsy is lower after removal of the lesion in combination with heat coagulation of its surrounding tissues than that after simple resection of the lesion.

关 键 词：幕上肿瘤 脑电描记术 手术后并发症 癫痫 

分 类 号：R739.41[医药卫生—肿瘤] R741.044[医药卫生—临床医学]