颞叶癫手术并发症的预防与处理  

Prevention and treatment of complications of surgery for temporal lobe epilepsy

作　　者：翟锋[1,2] 栾国明 周健[1,2] 牛弘川 张尧[2] 丁浩然 孙卫进[1] 陈嘉芃 

机构地区：[1]首都医科大学三博脑科医院功能神经外科,北京100093 [2]癫痫病临床医学研究北京市重点实验室,北京100093 [3]北京市脑重大疾病研究院癫痫病研究所,北京100093

出　　处：《中国微侵袭神经外科杂志》2018年第1期10-13,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：北京市科委“首都临床特色应用研究”(编号:Z161100000516131);首都卫生发展科研专项(编号:2016-1-8012);首都医科大学基础-临床科研合作基金课题(编号:15JL90)

摘　　要：目的探讨颞叶癫手术的并发症发生率及种类,分析总结发生原因及预防措施。方法回顾性分析行颞前叶及内侧结构切除且术后出现并发症的24例单侧颞叶癫病人的临床资料。结果术后出现偏瘫4例,对症治疗后痊愈。颅内感染8例,腰椎穿刺后痊愈7例,脓肿切除术后痊愈1例。周围性面瘫2例,颞肌萎缩3例,术后1年无改善。颅内血肿4例,再次手术清除血肿,无并发症发生。眼睑下垂2例,术后3个月恢复正常。脑积水1例,行脑室-腹腔分流术后恢复正常。结论颞叶癫手术存在一定的并发症,但如能熟悉颞叶及周围组织结构的解剖,熟练运用显微技术,严格按照标准操作,可以减少甚至避免某些并发症。Objective To investigate the incidence and types of complications of surgery for temporal lobe epilepsy and analyze their causes and precautions. Methods Clinical data of 24 unilateral temporal lobe epilepsy patients were analyzed retrospectively, who received anterior temporal lobe and medial structure resection with postoperative complications. Results The hemiplegia occurred in 4 patients, who recovered after symptomatic treatment. The intracranial infection occurred in 8 patients, seven recovered after lumbar puncture and 1 after excision of brain abscess. The peripheral facial paralysis occurred in 2 patients and temporal muscle atrophy in 3,who had no improvement 1 year after surgery. The intracranial hematoma occurred in 4 patients and received second surgery to remove the hematoma, and no complications was observed. Blepharoptosis occurred in 2 patients, who recovered 3 months after surgery. The hydrocephalus occurred in 1 patient and recovered after ventriculoperitoneal shunt. Conclusions There are certain complications of surgery for temporal lobe epilepsy, some of them can be reduced or even avoided by gaining familiarity with the anatomic structures of the temporal lobe and relevant tissues, mastering microtechnique, and following the rules of standard operation.

关 键 词：癫痫 颞叶 切除术 颞前叶及内侧结构 并发症 原因 预防 

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