脑裂头蚴病继发癫痫的诊疗分析  

Diagnosis and treatment of epilepsy secondary to cerebral sparganosis

作　　者：闫学强 李晓龙 谭家亮 吴杰 朱丹 Yan Xueqiang;Li Xiaolong;Tan Jialiang;Wu Jie;Zhu Dan(Department of Neurosurgery,Guangdong 999 Brain Hospital,Guangzhou 510510,China)

机构地区：[1]广东三九脑科医院神经外科,广州510510

出　　处：《中华神经医学杂志》2021年第5期501-506,共6页Chinese Journal of Neuromedicine

摘　　要：[摘要]目的探讨脑裂头蚴病继发癫痫的临床特点、诊疗方法及疗效。方法回顾性分析广东三九脑科医院神经外科自2004年7月至2019年5月确诊的62例脑裂头蚴病继发癫痫患者的临床资料。根据患者治疗意愿将其分为手术组(39例)及药物驱虫组(23例),手术组患者在导航辅助下开颅手术取虫并切除病灶,未取到活虫的患者行癫痫灶切除术或皮层热灼术。药物驱虫组.患者均予以吡喹酮治疗,剂量为60 mg/(kg·d),10d为1个疗程;间隔2个月后进行下一个疗程,直至达到治愈标准。所有患者随访1~8年,根据患者影像学资料、临床症状改善情况及裂头蚴抗体检测结果判断预后;同时采用改良Engel分级评估患者治疗1年后癫痫控制情况。结果39例手术组患者中34例取出活虫,共35条。随访1~8年后,手术组治愈34例,未愈5例;药物驱虫组治愈7例,未愈16例;手术组患者治愈率高于药物驱虫组(87.18%vs.30.43%),差异有统计学意义(P=0.000)。治疗后1年改良Engel分级结果显示,39例手术组患者中改良Engel分级Ⅰ级36例,Ⅱ级2例,Ⅲ级0例,Ⅳ级1例;23例药物驱虫组中改良Engel分级Ⅰ级9例,Ⅱ级3例,Ⅲ级5例,Ⅳ级6例,差异有统计学意义(Z=203.000,P=0.000),平均秩次提示手术组患者疗效优于药物驱虫组(25.21vs.42.17)。结论手术治疗脑裂头蚴病继发癫痫疗效优于药物驱虫治疗。Objective To explore the clinical characteristics,diagnostic methods,treatment strategies,and curative efficacies of epilepsy secondary to cerebral sparganosis.Methods A retrospective analysis on clinical data of 62 patients with epilepsy caused by cerebral sparganosis diagnosed in our hospital from July 2004 to May 2019 was performed.According to the treatment intention of the patients,these patients were divided into surgery group(n=39)and drug deworming group(n=23).Patients in the surgery group were treated with craniotomy assisted by navigation to remove worms anil lesions,and patients without live worms were treated with lesion resection or cortical burning.Patients in the drug deworming group were treated with praziquantel at a dose of 60 mg(kg·d)with 10 d as a course of treatment;the next course of treatment was followed at an interval of 2 months,and ended until the standard of cure was achieved.All patients were followed up for 1-8 years,and the prognoses were determined according to the imaging data,clinical symptom improvement and sparganosis antibody IgG detection results.The epilepsy control 1 year after treatment was assessed by modified Engel grading.Results Live worms were removed from 34 patients of the surgery group,with a total of 35 worms;after 1-8 years of follow-up.34 patients were cured and 5 patients were not cured in the surgery group;however,7 patients were cured and 16 patients were not cured in the drug deworming group;the cure rate in the surgery group was signficantly higher than that in the drug deworming group(P=0.000).Modified Engel grading Ⅰ was achieved in 36 patients,grading Ⅱ in 2 patients,grading Ⅲ in 0.and Ⅳ in Ⅰ patient of the surgery group;modified Engel grading I was achieved in 9 patients,grading Ⅱ in 3,grading Ⅲ in 5,and grading Ⅳ in 6 patients of the dmg deworming group:significant di fferences were noted between the two groups(Z=203.000,P=0.000);the mean rank suggested that the surgery group had better efficacy than the drug deworming group(25.21 vs.4

关 键 词：脑裂头蚴病 癫痫 外科手术 

分 类 号：R651.1[医药卫生—外科学] R742.1[医药卫生—临床医学]