儿童部分性癫痫切除性手术长期疗效分析  

The long- term outcomes of resection operation in children with partial epilepsy

作　　者：梁爽爽[1] 梁树立[1] 于晓曼[1] 张绍辉[1] 张军臣[4] 胡晓红[2] 蒋虹[3] 王晓朋[1] 张志文[1] 傅相平[1] 

机构地区：[1]解放军总医院第一附属医院神经外科,北京100048 [2]解放军总医院第一附属医院儿科,北京100048 [3]解放军总医院第一附属医院心理科,北京100048 [4]济宁医学院附属医院

出　　处：《中华神经外科杂志》2013年第1期12-16,共5页Chinese Journal of Neurosurgery

摘　　要：目的总结分析儿童部分性癫痫手术治疗效果和经验。方法回顾性分析2002年11月至2009年10月解放军总医院第一附属医院进行切除性手术治疗的278例6～14岁的部分性癫痫患者的临床资料。统计术后1年（1FU）、3年（3FU）和5年（5FU）癫痫控制情况，1FU时智商和生活质量的变化情况，比较癫痫发作形式、术前年龄、智商和手术方式等对手术效果的影响。结果1FU、3FU和5FU时癫痫无发作率为82．0％（228／278）、76．0％（130／171）和67．3％（72／107），其中病程≤5年和局限性病理灶对癫痫控制有明显影响。智商和生活质量术后1年复查完成223例，总智商改善93例（41．7％），其中以术后无癫痫发作、术前低智商和病程≤5年者改善明显。生活质量术后改善141例（63．2％），其中以联合胼胝体切开术和智商低者改善明显。结论手术可使合理选择的儿童部分性癫痫患者，癫痫发作得以控制、长期认知得到改善，有局限性病理灶和早期手术对提高手术疗效有利。Objective To analyze the long- term surgical outcomes for children with intractable partial epilepsy, and to introduce experiences on surgical candidate selection. Methods We retrospectively collected clinical data from 278 6 - 14 years old children with partial epilepsy that underwent epileptic surgeries at our center from November, 2002 to October, 2009. Surgical outcomes, including seizure controls at 1 year （1 FU）, 3 yrs （3FU）, and 5 yrs （5FU） after operations, and changes in intelligence quotient （IQ） and QOL from preoperative to 1FU were also collected. Results Postoperative seizure free was reduced in 228 （82. 0% ） children at 1FU, 130 （76. 0% ） cases at 3FU, and 67.3% at 5FU. Patients with focal MRI abnormalities and short histories of seizures were more likely to reach a good control of postoperative seizures. Complete postoperative IQ improvements occurred in 41.7% of 223 cases, and patients with postoperative seizures free, preoperative low - IQ and short histories of seizures showed obvious improvements. The percentage of QOL improvements was 63.2% and children with preoperative low - IQ, that underwent adjective corpus callosotomy, showed significant QOL improvements. Conclusion Epilepsy surgery is a promising technique for controlling seizures and improving the QOL for carefully selected Children with partial epilepsy. Focal pathologic lesions and short history of seizures are key factors for favorable seizure control.

关 键 词：儿童 部分性癫痫 生活质量 致痫灶切除术 胼胝体切开术 

分 类 号：R742.1[医药卫生—神经病学与精神病学]