以癫痫为首发症状的低级别胶质瘤患者的手术疗效及预后影响因素  

Factors associated with the surgical efficacy and prognosis of seizures in patients with low-grade glioma

作　　者：方富 林元相[1] 康德智[1] 王丰[1] 黄小芬[1] 余良宏[1] 林章雅[1] 

机构地区：[1]福建医科大学附属第一医院神经外科,福州350005

出　　处：《中华医学杂志》2016年第13期1031-1034,共4页National Medical Journal of China

基　　金：福建省临床重点专科建设项目;福建医科大学学科带头人培养对象专项基金（JXK201301）;福建医科大学教授发展基金（JS15014）

摘　　要：目的探讨影响癫痫为首发症状的低级别胶质瘤（LGG）患者手术疗效及预后因素。方法2010年1月至2014年12月，回顾性的收集福建医科大学附属第一医院神经外科收治的以癫痫为首发症状的LGG患者45例，对可能影响手术疗效及预后的相关因素进行分析。结果首发症状为癫痫的LGG病例共45例，术后随访1～5年，EngelⅠ～Ⅱ级36例（80％），Ⅲ-Ⅳ级9例（20％）。术前癫痫发作频次与术中是否应用皮质脑电图（ECoG）监测对首发症状为癫痫的LGG患者手术疗效及预后的影响差异有统计学意义（P〈0．05）。其他因素如年龄、性别、癫痫病程、肿瘤级别、大小以及部位对手术疗效及预后的影响差异无统计学意义。结论首发症状为癫痫的LGG患者手术疗效较好。影响首发症状为癫痫的LGG患者手术疗效及预后的因素是术前癫痫发作频次与术中是否应用ECoG监测。采用外科手术治疗首发症状为癫痫的LGG患者，应尽可能在切除肿瘤的基础上应用ECoG监测对癫痫病灶进行处理。Objective To explore the relevant factors associated with the surgieal efficacy and prognosis of seizures in patients with low-grade glioma （LGG）. Methods The clinical eases of seizures in patients with LGG admitted to our department were retrospectively collected from January 2010 to December 2014. A total of 45 eases were studied to analyze the relevant factors associated with the surgical efficacy and prognosis. Results During a follow-up period of 1 to 5 years after surgery, Engel class Ⅰ to Ⅱ were achieved in 36 patients （ 80% ） and Engel elass Ⅲ to Ⅳ in 9 eases （20%）. The preoperative epilepsy frequency and the use of intraoperative electrocardiograph （ECoG） were correlated with the surgical efficacy and prognosis （P〈 0. 05）. The other factors, such as age, gender, duration of epilepsy, and tumor characteristics, had no significant statistical difference. Conclusions The surgical efficacy of seizures in patients with LGG is favorable. Our results suggest that preoperative epilepsy frequency and intraoperative ECoG are important factors for surgical efficacy and prognosis. Consequently, based on gross total resection for seizures in patients with LGG, epileptogenie zones should be considered and dealt with by use of ECoG.

关 键 词：癫痫 低级别胶质瘤 皮层脑电图 显微手术 预后 

分 类 号：R739.41[医药卫生—肿瘤]