影响颞叶癫痫再次手术疗效的相关分析  

Correlative Analysis of Surgical Effect on Temporal Lobe Epilepsy for Second Operation

作　　者：张杰[1] 吴建兵 杜春富 高晋健 冯文 张桓 陈昌平 

机构地区：[1]雅安市人民医院神经外科,四川雅安625000 [2]西南医科大学附属成都市西区医院神经外科,四川成都610030 [3]西南医科大学附属成都三六三医院神经外科,四川成都610041

出　　处：《西南军医》2018年第1期19-23,共5页Journal of Military Surgeon in Southwest China

基　　金：四川省科技支撑计划项目(编号:2011FZ0032)

摘　　要：目的评估影响颞叶癫痫患者再次手术预后相关因素。方法回顾性分析2004年1月-2015年1月西南医科大学附属成都三六三医院神经外科再次手术的颞叶癫痫患者18例(其中4例由外院转入),分析术后癫痫控制情况、组织病理、抗癫痫用药种类等临床资料,所有患者至少随访1.5年。结果根据Engel分级,EngelⅠ级4例(22.2%),EngelⅡ级5例(27.8%),EngelⅢ级3例(16.7%),EngelⅣ级6例(33.3%)。单因素比较结果显示较好的手术预后与初次手术前抗癫痫药物种类小于3种(P=0.023)颞叶内侧结构残留(P=0.022)相关,较差的预后因素为多灶性皮质发育不良(P=0.025)、棘波多灶性起源(P=0.028)。患者的病程、发病年龄、手术年龄以及是否为双侧颞叶癫痫组间比较,差异无统计学意义(P>0.05)。Logistic回归分析显示多灶性皮质发育不良(OR 8.042 P=0.008)及脑电检测棘波多灶性起源(OR 2.633 P=0.005)是影响颞叶癫痫再次手术的危险因素。结论再次手术能使部分患者获益,多灶性皮质发育不良及脑电检测棘波多灶性起源是影响颞叶癫痫再次手术的危险因素。Objective To evaluate the correlative factors on the prognosis of the patients with temporal lobe epilepsy for second operation. Methods A retrospective analysis was made to the clinical data of 18 cases with temporal lobe epilepsy who received the second operation during the period from Jan. , 2004 to Jan. , 2015 in Chengdu 363 Hospital affiliated to Southwest Medical University, including the control of epilepsy, histopathologieal study and the types of antiepileptie drugs administrated; all the cases were followed up for 1.5 years at least. Results According to Engel outcome classification system, 4 cases were Engel I （22.2%）, 5 cases were Enge] II （27.8%）, 3 cases were Engel III（ 16.7% ） and 6 cases were Engel IV （33.3%） ; single factor analysis showed that better prognosis was correlated to the application of antiepileptic drugs less than 3 types before the first operation （ P = 0. 023 ） and residual medial temporal lobe structure （P = 0. 022） while poorer prognosis was correlated to muhifocal cerebral cortical dysplasia （P = 0. 025）, and multi - originated spike waves （ P = 0. 028 ） ; comparison in disease course, onset age, operation age, unilateral or bilateral temporal lobe epilepsy among the cases was of no statistical difference （P 〉 0.05 ） ; Logistic regression analysis indicated that multifoeal cerebral cortical dysplasia （ OR ： 8. 042, P = 0. 008） and multi - origina-ted spike waves （OR： 2. 633 ,P = 0. 005） were independent risk factors for the seeond operation. Conclusions The second operation may lead to better prognosis in some patients with temporal lobe epilepsy; multifoeal cerebral cortical dysplasia and multi -originated spike waves are independent risk factors for the second operation.

关 键 词：难治性颞叶癫痫 再次手术 疗效 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学]