前颞叶切除术与颞下入路选择性海马杏仁核切除术治疗颞叶内侧癫痫疗效对比  

Efficacy of anterior temporal lobectomy and selective amygdalohippocampectomy via subtemporal approach in the treatment of medial temporal lobe epilepsy and influence on postoperative complications and neuropsychology

作　　者：杨子茵 高安亮 李佳宇 黄军 李宁 倪艳 YANG Ziyin;GAO Anliang;LI Jiayu;HUANG Jun;LI Ning;NI Yan(Department of Neurosurgery,The Second Affiliated Hospital of Chengdu Medical College,Nuclear Industry 416 Hospital,Chengdu 610052,China)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院神经外科,四川成都610052

出　　处：《西部医学》2022年第4期566-570,共5页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会科研课题(17PJ189)。

摘　　要：目的对比皮层脑电图监测下前颞叶切除术(ATL术)与颞下入路选择性海马杏仁核切除术(SAH术)在颞叶内侧癫痫患者中的应用效果及对术后并发症及神经心理学影响。方法回顾性分析2010年1月~2019年6月我院98例颞叶内侧癫痫手术患者临床资料,依据术式不同分为ATL组53例、SAH组45例。比较两组围术期指标及术后并发症。术后随访1年,依据Engel’s分级统计两组癫痫控制情况,并采用韦氏成人智力量表(WAIS-RC)、韦氏记忆量表(WMS)评价手术对患者神经心理学影响。结果两组手术时间、术中失血比、术后住院时间及术后用药情况比较,差异无统计学意义(均P>0.05)。ALT组术后并发症总发生率高于较SAH组,差异有统计学意义(P<0.05)。术后1年,两组癫痫控制Engel’s分级及总有效率比较,差异无统计学意义(均P>0.05)。术后1年,ALT组WAIS-RC评估中PIQ、VIQ、FIQ及WMS评估中MQ、VM与术前比较,差异无统计学意义(P>0.05),但SAH组VIQ、MQ明显高于术前(P<0.05),且VIQ、MQ明显高于同时间点ALT组(P<0.05)。结论ATL术或颞下入路SAH术控制颞叶内侧癫痫患者癫痫发作疗效均较好,而颞下入路SAH术在降低术后并发症风险、促进言语智商及记忆商恢复方面有积极意义。Objective To compare the application effect of anterior temporal lobectomy(ATL)and selective amygdalohippocampectomy via subtemporal approach(SAH)under the cortical electroencephalogram monitoring on patients with medial temporal lobe epilepsy,and the influence on postoperative complications and neuropsychology.Methods The clinical data of 98 patients with surgery for medial temporal lobe epilepsy from January 2010 to June 2019 were retrospectively analyzed.According to the different surgical methods,the patients were divided into ATL group(53 cases)and SAH group(45 cases).The perioperative indexes and postoperative complications were compared between the two groups.At 1 year of follow-up after surgery,the epilepsy control status was statistically analyzed in the two groups according to the Engel’s classification.Wechsler Adult Intelligence Scale(WAIS-RC)and Wechsler Memory Scale(WMS)were used to evaluate the influence of surgery on neuropsychology of patients.Results There were no significant differences in the surgical time,intraoperative blood loss ratio,postoperative hospital stay and postoperative medication status between the two groups(P>0.05).The total incidence rate of postoperative complications in ALT group was higher than that in SAH group(18.87%vs 4.44%)(P<0.05).At 1 year after surgery,there was no significant difference in the Engel’s classification of epilepsy control between the two groups(P>0.05).There was no significant difference in the total effective rate between ALT group and SAH group(94.34%vs 91.11%)(P>0.05).At 1 year after surgery,there were no significant differences in the PIQ,VIQ and FIQ of WAIS-RC scale and MQ and VM of WMS scale in ALT group compared with those before surgery(P>0.05),but the VIQ and MQ in SAH group were significantly higher than those before surgery(P<0.05),and the VIQ and MQ were significantly higher than those in ALT group at the same time point(P<0.05).Conclusion Both ATL surgery or SAH surgery via subtemporal approach can better control epileptic seizures in

关 键 词：颞叶内侧癫痫 前颞叶切除 选择性海马杏仁核切除 Engel’s分级 并发症 神经心理学 

分 类 号：R742.1[医药卫生—神经病学与精神病学]