显微外科治疗难治性颞叶癫痫102例  

Microsurgical Treatment for Refractory Temporal Lobe Epilepsy: a Report of 102 Cases

作　　者：黄金城[1] 于凯[1] 

机构地区：[1]福建医科大学附属泉州第一医院重症医学科,泉州362000

出　　处：《中国微创外科杂志》2014年第12期1100-1102,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨显微外科治疗难治性颞叶癫痫的疗效。方法2005年1月～2011年12月通过术前综合评估定位，术中额颞翼点切口，显微外科切除致痫灶治疗难治性颞叶癫痫102例。采用Engel标准评定术后疗效；将自理能力、学习能力、工作能力3个指标作为生活质量的评定标准，对比术前及术后1年9月各项指标的差异。结果102例随访1年9个月～7年，术后无因该病死亡及严重手术并发症发生。术后1年Engel评定疗效：I级61例（59．8％）发作完全消失，Ⅱ级17例（16．7％）极少发作，Ⅲ级13例（12．7％）发作减少75％以上，Ⅳ级无效11例（10．8％），有效率89．2％（91／102），优良率76．5％（78／102）。术后1年9个月患者自理情况：不能自理6例，部分自理32例，完全自理64例，术前分别为21、67、14例，术前后比较有统计学差异（Z=-7．001，P=0．000）。67例青少年及儿童患者学习能力术前后有统计学差异（Z=-3．747，P=0．000）；35例成人患者工作能力术前后有统计学差异（Z=-2．564，P=0．010）。结论显微外科治疗难治性颞叶癫痫患者生活质量明显改善，疗效满意。Objective To explore the effect of microsurgery for refractory temporal lobe epilepsy. Methods A retrospective analysis was made in 102 patients with refractory temporal lobe epilepsy from January 2005 to December 2011. The patients received comprehensive preoperative localization, intraoperative frontotemporal pterional incision, and microsurgical resection of epileptogenic focus. The efficacy was evaluated according to the Engel standards. Indications such as self-care ability, learning ability, and working ability were used to evaluate the quality of life, which were recorded and compared before and after operation. Results Follow-up was accomplished in all the 102 cases for a duration of 1 year and 9 months to 7 years. There were no mortality and serious complications. The effects evaluations at 1 year after operation showed complete disappearance of symptoms （level I ） in 61 cases （59.8%）, almost disappearance （level II ） in 17 cases （ 16.7% ）, symptoms improvement more than 75% （level Ⅲ） in 13 cases （ 12.7% ） ,and ineffective （level IV ） in 11 cases （ 10.8% ）, bearing an effective rate of 89.2% （91/102） and a good-and- excellent rate of 76.5% （78/102）. At one year and nine months postoperatively, 6 patients could not take care of themselves, 32 patients obtained partial self-care, and 64 patients had complete self-care, as compared with which there were 21 patients, 67 patients, and 14 patients preoperatively, respectively, having significant differences before and after surgery （Z = - 7. 001, P = 0. 000）. Statistical significances were obtained before and after operation in 67 cases of children and adolescents with learning ability （Z = - 3. 747, P = 0. 000） and in 35 adult cases with working ability （ Z = - 2. 564, P = O. 010）. Conclusions Microsurgical treatment is an effective method for refractory temporal lobe epilepsy. Patients＇ quality of life can get significant improvement after surgery.

关 键 词：难治性颞叶癫痫 显微外科 癫痫灶定位 Engel标准 生活质量 

分 类 号：R742.1[医药卫生—神经病学与精神病学]