半球性癫痫手术治疗的疗效分析  

Analysis of effects on hemispheric epilepsy with surgical treatment

作　　者：代金东[1] 王晓飞[1] 梅珊珊[1] 马康平[1] 刘庆祝[1] 杨玉成[1] 秦广彪[1] 谭泊静[1] 李云林[1] 

机构地区：[1]北京市海淀医院(北京大学第三医院海淀院区)功能神经科,100080

出　　处：《临床神经外科杂志》2016年第1期35-39,共5页Journal of Clinical Neurosurgery

摘　　要：目的探讨外科手术治疗半球性癫痫的疗效,评价手术对患者的社会心理及认知功能的影响。方法 93例半球性癫痫患者经过综合评估后行手术治疗,其中Adams＇s术式30例,Rasmussen＇s术式7例,大脑半球切开术3例,多脑叶切除术24例,多脑叶切除联合胼胝体切开术29例。术后随访2.5年~6年3个月。手术疗效以Engel分级标准判定。结果术后癫痫控制情况：EngelⅠ级43例,Ⅱ级24例,Ⅲ级19例,Ⅳ7例。手术后早期患者的偏瘫无明显加重,肌张力及痉挛状态得到不同程度缓解,辅助系统康复训练后,肢体功能明显改善;高级皮层功能,生活自理能力和社会适应能力得到不同程度的提高。结论手术治疗半球性癫痫不仅可有效控制癫痫发作,患者的言语、肢体运动功能无恶化,神经心理功能和生活质量还有不同程度提高。而上述功能改善程度与年龄呈正相关。Object To explore the efficacy of hemispheric epilepsy by surgical treatment and evaluate patients psychosocial and cognitive function after operation.Methods The authors performed a retrospective review of 93 patients.According to the preoperative comprehensive evaluations,30 accepted performed Adams anatomical hemispherectomy,7 accepted Rasmussen functional hemispherectomy,3 accepted hemispherotomy,while 24 accepted multilobe-sections.The latter 29 cases accepted multilobe-sections and corpus callosotomy.Continuous follow-up 2.5 years to 6 years and 3 months.Results According to Engel curative effect classification,43 patients were seizure free at the termination of the study.50 patients who were not seizure free.All cases had significant reduction of seizure frequency,24 patients achieved Engel Class Ⅱ outcome,19 Engel Class Ⅲ and 7 patients Engel Class Ⅳ.The efficacy of hemispherotomy was remarkable over time with no significant change over the postoperative follow-up period.Hemiplegia of patients were not exacerbate,and muscular tension and spasticity of the trouble side were obvious reduced.Through the systematic Physical rehabilitation and neural function rehabilitation training,Limb function is obviously improved,Higher cortical functions,Life self-care ability.Social adaptation ability to different degrees of improvement.Conclusions Cerebral hemispheric surgery is safe and feasible.Epilepsy has been effectively controlled.The verbal ability of patients with postoperative function not affected,social mental psychological condition improved markedly,the quality of life has improved significantly,plasticity of hemispheric function is related with age of onset.

关 键 词：药物难治性癫痫 手术治疗 疗效分析 

分 类 号：R739.4[医药卫生—肿瘤]