中老年癫痫的外科治疗  

Epilepsy surgery in middle and old age people

作　　者：丁平[1] 张绍辉[1] 吴洵昳 于晓曼[1] 袁柳 梁爽爽[1] 刘娜[1] 梁树立[3] Ding Ping;Zhang Shaohui;Wu Xunyi;Yu Xiaoman;Yuan Liu;Liang Shuangshuang;Liu Na;Liang Shuli(Department of Neurosurgery,First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第一附属医院神经外科,北京100048 [2]复旦大学附属华山医院神经内科 [3]解放军总医院神经外科

出　　处：《中华老年心脑血管病杂志》2018年第9期972-976,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金(81271437;81771388)

摘　　要：目的探讨中老年癫痫患者的病例特点、手术治疗及临床疗效。方法收集进行切除性手术治疗的癫痫患者106例,以年龄45岁为界分为中老年组34例,青年组72例。回顾性分析2组术后2年及末次随访的手术疗效和并发症等临床资料。结果术后2年随访青年组癫痫控制达到EngelⅠ~Ⅱ级87.5%,中老年组为85.3%,末次随访分别为79.2%和76.5%,2组比较无统计学差异(P>0.05)。2组病理检测、并发症和智商、记忆商及生活质量改变比较无明显差异(P>0.05)。MRI局限性异常和术前发作频率低是中老年组中术后2年无发作的预测因素。中老年组术后癫痫未发作患者智商[(1.05±3.84)分vs(-3.00±2.00)分]、记忆商[(-0.22±3.61)分vs(-4.00±2.67)分]及生活质量[(4.11±1.68)分vs(1.00±2.00)分]变化较癫痫发作患者明显,差异有统计学意义(P<0.05)。结论中老年癫痫手术效果及手术并发症(包括认知损害)与低年龄患者无明显差异,故对于药物难性中老年癫痫,特别是MRI局限性异常患者,应当积极考虑术前评估和手术治疗。Objective To study the clinical characteristics,surgical treatment and outcomes of middle and old age epilepsy patients.Methods Of the 106 epilepsy patients admitted to our hospital for resective epilepsy surgery,34 aged ≥45 years served as a middle and old age group and 72 aged 35-44 years served as a young age group.Their clinical data were retrospectively analyzed,including operative efficacy and complications during the 2-year follow-up period and at the last follow-up time.Results The control rate of epilepsy was 87.5% Engel Ⅰ-Ⅱ in young age group and 85.3% EngelⅠ-Ⅱin middle and old age group during the 2-year follow-up period and was 79.2% EngelⅠ-Ⅱin young age group and 76.5% EngelⅠ-Ⅱin middle and old age group at the last follow-up time（P〉0.05）.No significant difference was found in pathological findings,complications,intelligence quotient（IQ）,memory quotient（MQ）and quality of life（QOL）between the two groups（P〉0.05）.Focal abnormality on MRI and low frequency of preoperative epilepsy seizure were the predictors of no postoperative epilepsy seizure.The postoperative IQ and MQ were higher and the postoperative QOL was better in epilepsy seizure-free patients than in epilepsy seizure patients（P〈0.05）.Conclusion No significant difference is found in surgical outcome and complications among young,middle and old age epilepsy patients.Preoperative assessment and surgical treatment should thus be considered for middle and old age refractory epilepsy patients,especially for those with focal abnormality on MRI.

关 键 词：癫痫 外科手术 前颞叶切除术 生活质量 

分 类 号：R651.11[医药卫生—外科学]