不同FCD分型所致药物难治性癫痫患者的手术预后影响因素  

Analysis of prognostic factors in patients with drug-refractory epilepsy caused by different FCD classification after surgical treatment

作　　者：薛亚飞 景芸芸[2] 张玉富 XUE Ya-fei;JING Yun-yun;ZHANG Yu-fu(Department of Neurosurgery,the Tangdu Hospital of Air Force Military Medical University,Xi'an 710000,Shaanxi,CHINA;Department of Neurology,The Central Hospital of Xi'an City,Xi'an 710000,Shaanxi,CHINA)

机构地区：[1]空军军医大学唐都医院神经外科,陕西西安710000 [2]西安市中心医院神经内科,陕西西安710000

出　　处：《海南医学》2019年第16期2085-2088,共4页Hainan Medical Journal

摘　　要：目的研究不同分型局灶性皮质发育不良(FCD)所致的药物难治性癫痫患者行手术治疗后的预后影响因素。方法选取2013年3月至2016年4月期间空军军医大学唐都医院收治的药物难治性癫痫患者87例作为研究对象,患者均经过手术治疗,并且术后病理均证实为FCD,根据患者的病理分型将其分为FCDⅠ型33例、FCDⅡ型28例、FCDⅢ型26例,对所有患者进行随访,采用Engel分级分析患者预后,再根据患者预后情况采用单因素与多因素Logistic回归分析不同患者手术预后的相关影响因素。结果根据随访结果显示,FCDⅠ型患者EngelⅠ级27例(81.82%)、Ⅱ级3例(9.09%)、Ⅲ级2例(6.06%)、Ⅳ级1例(3.03%);Ⅱ型患者EngelⅠ级18例(64.29%)、Ⅱ级3例(10.71%)、Ⅲ级4例(12.29%)、Ⅳ级3例(10.71%);Ⅲ型患者EngelⅠ级8例(30.77%)、Ⅱ级7例(26.92%)、Ⅲ级6例(23.08%)、Ⅳ级5例(19.23%);以上不同FCD分型患者的Engel分级中,除Ⅲ级外,Ⅰ级、Ⅱ级、Ⅳ级比较,差异均有统计学意义(P<0.05);预后良好者53例,不良者34例,根据单因素分析结果显示,临床发作类型、PET-CT表现、病灶部位、切除范围、病理分型是影响患者预后的影响因素(P<0.05);多因素Logistic回归分析结果显示,临床发作类型、切除范围、病理分型是影响患者预后的独立危险因素(P<0.05)。结论不同FCD分型药物难治性癫痫患者手术后影响预后的独立危险因素为临床发作类型、切除范围、病理分型。Objective To study the prognostic factors of drug-refractory epilepsy patients with drug-refractory epilepsy caused by different types of focal cortical dysplasia(FCD).Methods From March 2013 to April 2016,87 patients with drug-refractory epilepsy were selected as subjects.All patients were surgically and pathologically proved to be FCD.The patients were divided into FCD typeⅠ(33 cases),FCD typeⅡ(28 cases)and FCDⅢ(26 cases)according to their pathological types.All patients were followed up and the prognosis was analyzed by Engel classification.According to the prognosis,univariate and multivariate logistic regression were used to analyze the influencing factors of surgical prognosis in different patients.Results According to the follow-up results,there were 27 cases of EngelⅠ(81.82%),3 cases of EngelⅡ(9.09%),2 cases of EngleⅢ(6.06%)and 1 case of EngelⅣ(3.03%)in the FCD typeⅠpatients;there were 18 cases of EngelⅠ(64.29%),3 cases of EngelⅡ(10.71%),4 cases of EngelⅢ(12.29%)and 3 cases of EngelⅣ(10.71%)in the FCD typeⅡpatients;there were 8 cases of EngelⅠ(30.77%),7 cases of EngelⅡ(26.92%),6 cases of EngelⅢ(23.08%)and 5 cases of EngelⅣ(19.23%)in the FCDⅢpatients.Between the Engel classifications of the above patients with different FCD types,except gradeⅢ,there were significant differences in gradeⅠ,grade II and gradeⅣ(all P<0.05).There were 53 patients with good prognosis and 34 patients with poor prognosis.According to univariate analysis,the influencing factors of prognosis were clinical attack type,PET-CT manifestation,lesion location,resection range and pathological classification(P<0.05).Multivariate logistic regression analysis showed that clinical attack type,resection range and pathological type were independent risk factors affecting the prognosis of patients(P<0.05).Conclusion The independent risk factors that affect the prognosis of patients with refractory epilepsy in different FCD types are the type of clinical attack,the scope of resection and the pathological c

关 键 词：病理分型 局灶性皮质发育不良 药物难治性癫痫 手术治疗 预后 影响因素 

分 类 号：R742.1[医药卫生—神经病学与精神病学]