双重病理征对药物难治性颞叶内侧癫痫手术预后的影响  

Effect of mesial temporal sclerosis and focal cortical dysplasia on the surgical outcomes of patients with medically refractory mesial temporal lobe epilepsy

作　　者：艾热木古丽·阿不都热依木 秦虎[1] 张丽娜[1] 汪永新[1] LREMUKULI Abedureyimu;QIN Hu;ZHANG Li-na;WANG Yong-xin(Department of Neurosurgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 841100,China)

机构地区：[1]新疆医科大学第一附属医院神经外科,乌鲁木齐841100

出　　处：《中国临床神经外科杂志》2023年第2期80-82,共3页Chinese Journal of Clinical Neurosurgery

基　　金：上海合作组织科技伙伴计划及国际科技合作计划(2021E01013)。

摘　　要：目的探讨内侧颞叶硬化(MTS)合并局灶性皮质发育不良(FCD)对药物难治性颞叶内侧癫痫(MTLE)手术预后的影响。方法回顾性分析2010年1月至2020年3月前颞叶切除术治疗的98例药物难治性MTLE的临床资料。术后2年,应用Engel分级评估预后,其中Ⅰ级为预后良好,Ⅱ~Ⅳ级为预后不良。结果98例中,预后良好70例(71.4%),预后不良28例(其中Engel分级Ⅱ级8例、Ⅲ级5例、Ⅳ级15例)。术后病理检查显示,39例(39.8%)存在MTS合并FCD。多因素logistic回归分析显示,MTS合并FCD是MTLE手术预后不良的独立危险因素(P=0.009,OR=1.114,95%CI 1.033~3.393)。结论前颞叶切除术是治疗药物难治性MTLE的一种有效手术方法,MTS合并FCD的药物难治性MTLE病人手术预后较差。Objective To investigate the effect of mesial temporal sclerosis(MTS)and focal cortical dysplasia(FCD)on the surgical outcomes of patients with medically refractory mesial temporal lobe epilepsy(MTLE).Methods The clinical data of 98 patients with drug-resistant MTLE who were treated with anterior temporal lobectomy from January 2010 to March 2020 were retrospectively analyzed.Two years after the surgery,the Engel class was used to evaluate the prognosis,of which classⅠwas a good prognosis,and classⅡ~Ⅳwas a poor prognosis.Results Of these 98 patients,70 patients(71.4%)had good prognoses,and 28 had poor prognoses(8 were classⅡ,5 were classⅢ,and 15 were classⅣ).Postoperative pathological examination showed that 39 patients(39.8%)had MTS complicated with FCD.Multivariate logistic regression analysis showed that MTS associated with FCD was an independent risk factor for poor prognosis of patients with drug-resistant MTLE after the surgery(P=0.009,OR=1.114,95%CI 1.033~3.393).Conclusions Anterior temporal lobectomy is an effective surgical method for patients with drug-resistant MTLE.The prognosis is poor in patients with drug resistant MTLE associated with MTS and FCD.

关 键 词：药物难治性癫痫 颞叶内侧癫痫 前颞叶切除术 内侧颞叶硬化 局灶性皮质发育不良 预后 

分 类 号：R742.1[医药卫生—神经病学与精神病学] R651.11[医药卫生—临床医学]