颞顶枕离断术治疗儿童单侧多脑叶难治性癫痫  

Disconnective surgery for unilateral posterior quadrantic epilepsy: a series of 17 paediatric patients

作　　者：杨朋范[1] 梅珍[2] 张辉建[1] 裴家生[1] 林巧[2] 贾延增 钟忠辉[2] 

机构地区：[1]福建医科大学福总临床医学院神经外科,福州350025 [2]福建医科大学福总临床医学院癫痫中心,福州350025

出　　处：《中国临床神经外科杂志》2015年第10期605-608,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颞顶枕离断术治疗儿童单侧多脑叶药物难治性癫痫的效果。方法回顾性分析2009年9月至2014年5月在我院接受颞顶枕离断术治疗的17例儿童癫痫患者的临床资料,其中16例行单侧颞顶枕离断术,1例行前颞叶切除术后再行顶枕离断术。所有患者术后随访13~66个月,平均33.7个月。结果按Engel分级评定癫痫控制效果：Ⅰ级10例,Ⅱ级3例,Ⅲ级3例,Ⅳ级1例。术前总智商为（47.3±11.2）分,术后为（56.7±9.7）分,两者差异显著（P〈0.05）。17例患儿术后均出现对侧偏盲;2例术后第5天出现严重脑水肿,其中1例再次开颅手术切除枕叶。结论对致痫灶广泛分布于一侧的颞顶枕叶癫痫的儿童患者,颞顶枕离断术是安全有效的治疗方法。ObjectiveTo assess the curative effects of temporo-parieto-occipital（TPO） disconnection surgery on intractableposterior quadrantic epilepsy（IPQE） induced by the unilateral posterior quadrant lesion（UPQL） in children.MethodsThe clinical dataof 17 children with IPQE induced by UPQL, who underwent TPO disconnective surgery from September, 2009 to September, 2012, wereanalyzed retrospectively. Only TPO disconnection was performed in 16 patients and the parieto-occipital disconnection was performed 1 year after the ipsilateral anterior temporal lobectomy in 1 patient.ResultsThe mean ages at seizure onset and at surgery were 3.5 and10.4 years respectively. All the patients were followed up from 13 to 66 months（mean, 33.7 months）. The curative effects were assessedaccording to Engel classification. Of 17 patients, 10（58.8%） had Engel classⅠ curative effect, 3 classⅡ, 3 class Ⅲ, and 1 class Ⅳ. Allthe children had contralateral hemianopia after the surgery. Of 2 patients suffered from severe brain edema 5 days after the surgery, 1underwent an operation again and 1 not.ConclusionTPO disconnection is a safe and effective method to treat intractable epilepsy in thechildren with the epileptiform zone extensively located in unilateral TPO lobes.

关 键 词：难治性癫痫 儿童 颞顶枕离断术 疗效 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]