对比手术与药物治疗脑海绵状血管畸形所致癫痫的疗效与安全性分析  

Comparative Analysis of Efficacy and Safety of Surgery and Drugs in the Treatment of Epilepsy Caused by Cerebral Cavernous Vascular Malformation

作　　者：许育伟 陈子怡[2] 朱燕珍[2] 莫蓉[2] 曾宪杰 XU Yu-wei;CHEN Zi-yi;ZHU Yan-zhen;MO Rong;ZENG Xian-jie(Department of Neurology,Chaozhou Peoples Hospital,Chaozhou 521000,China;Department of Neurology,National Key Clinical Department and Key Discipline of Neurology,The First Affiliated Hospital,Sun Yat-sen University,Guang-zhou 510080,China)

机构地区：[1]潮州市人民医院神经内科,广东潮州521000 [2]中山大学附属第一医院神经科//国家临床重点专科、重点学科,广东广州510080

出　　处：《中山大学学报（医学科学版）》2021年第2期266-270,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81000554,81801287,81971203);广东省自然科学基金(2017A030310079,2018A030313345)。

摘　　要：【目的】探讨不同治疗方式对脑海绵状血管畸形所致癫痫的疗效、安全性与影响因素。【方法】回顾性分析71例以癫痫为主要表现的脑海绵状血管畸形患者,根据是否通过手术治疗癫痫病灶分为单纯药物治疗组42例,手术联合药物治疗组(简称手术组)共29例,分析两者治疗效果。【结果】药物组与手术组疗效比较,药物组有效32例(76.2%),手术组有效22例(75.9%),两组差异无统计学意义(P>0.05)。但对病灶数目进行亚组分析发现,多发病灶患者中,药物组有效3例(75.0%),手术组有效0例数(0%),药物组有效率高于手术组;单发病灶患者中,药物组有效28例(73.7%),手术组有效22例(95.7%),手术治疗对单发病灶患者的有效率优于单纯药物组(P<0.05)。脑电图严重程度与治疗效果差异无统计学意义(P>0.05)。【结论】药物治疗和手术治疗海绵状血管畸形所致癫痫疗效相当,但手术治疗可能出现术后并发症而影响预后。单个海绵状血管畸形导致癫痫患者,建议手术治疗,多发性海绵状血管畸形所致癫痫患者,手术治疗需慎重。【Objective】To explore the efficacy,safety and influencing factors of different treatment methods for epilep⁃sy caused by cerebral cavernous malformations.【Methods】We retrospectively enrolled 71 patients with cerebral cavernous malformation with epilepsy as the main manifestation,who were divided into a drug-only group of 42 patients and a sur⁃gery combined with drug therapy group(surgery group)of 29 patients.The effects of both treatments were analyzed.【Re⁃sults】Comparison of the efficacy between the drug group and the surgery group showed that 32(76.2%)were effective in the former while 22(75.9%)were effective in the latter;there was no statistical difference between the two groups(P>0.05)However,a subgroup analysis of the number of lesions found that among patients with multiple lesions,3(75.0%)were effective in the drug group,as compared with 0(0%)in the surgical group,and the effective rate of the drug group was higher than that of the surgical group.Among patients with a single lesion,the effective rate was higher in the surgical group than that in drug group with statistical significance[22(95.7%)vs.28(73.7%),P<0.05].There was no significant difference between the severity of EEG and the treatment effect(P>0.05).【Conclusions】Effectiveness of Drug therapy and surgical treatment of spongiform plasma malformations caused by epilepsy was similar,but surgical treatment may have postoperative complications and affect the prognosis.Patients with epilepsy caused by a single cavernous vascular malfor⁃mation are recommended to be treated with surgery,while patients with epilepsy caused by multiple cavernous vascular malformations should be treated with caution.

关 键 词：脑海绵状血管畸形 癫痫 药物治疗 手术治疗 

分 类 号：R741[医药卫生—神经病学与精神病学]