药物难治性癫痫首次手术失败的原因分析及再次手术的疗效  

Causes of failure of the first operation and outcomes of reoperation for patients with drug-resistant epilepsy

作　　者：石先俊 邓静 孙晓琴 刘立红 王中科 张春青 刘仕勇 SHI Xian-jun;DENG Jing;SUN Xiao-qin;LIU Li-hong;WANG Zhong-ke;ZHANG Chun-qing;LIU Shi-yong(Department of Neurosurgery,Xinqiao Hospital,Army Medical University,Chongqing 400037,China;Department of Neurosurgery,Armed Police Hospital of Chongqing,Chongqing 400061,China)

机构地区：[1]陆军军医大学新桥医院神经外科,重庆400037 [2]武警重庆总队医院神经外科,重庆400061

出　　处：《中国临床神经外科杂志》2023年第5期303-306,310,共5页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨药物难治性癫痫首次手术失败的原因及再次手术的疗效。方法回顾性分析2009年1月~2021年10月再次手术治疗的35例药物难治性癫痫病人的临床资料。末次随访,采用Engle分级评估疗效,其中Ⅰ~Ⅱ级为疗效优良,Ⅲ~Ⅳ级为疗效不佳。结果首次手术失败的原因:致痫灶不完全切除12例,肿瘤复发10例,定位错误2例,原因不明11例。35例术后随访1~12年,中位数3.4年;末次随访,Engle分级Ⅰ级19例(54.3%),Ⅱ级7例(20.0%),Ⅲ级7例(20.0%),Ⅳ级2例(5.7%);疗效优良26例(74.3%),其中致痫灶不完全切除病人的优良率为75.0%(9/12),肿瘤复发病人的优良率为100.0%(10/10),定位错误病人分优良率为100.0%(2/2),原因不明病人的优良率为45.5%(5/11)。结论药物难治性癫痫首次手术失败后,综合评估失败原因,根据失败原因选择合适的手术方案,可获得良好预后;但是首次手术失败原因不明的病人,再次手术需谨慎。Objective To investigate the causes of failure of the first operation and the outcomes of reoperation for patients with drug refractory epilepsy.Methods The clinical data of 35 patients with drug-resistant epilepsy who underwent reoperation from January 2009 to October 2021 were retrospectively analyzed.At the last follow-up,Engle class was used to evaluate the efficacy,of which classⅠ~Ⅱwas excellent and good,classⅢ~Ⅳwas poor.Results The causes for the failure of the first operation included incomplete excision of epileptogenic foci in 12 patients,tumor recurrence in 10 patients,location error in 2 patients and unknown causes in 11 patients.The follow up 35 patients ranged from 1 year to 12 years,with a median of 3.4 years.At the last follow-up,Engle classⅠwas achieved in 19 patients(54.3%),Engle classⅡin 7 patients(20.0%),Engle classⅢin 7 patients(20.0%),and Engle classⅣin 2 patients(5.7%).The efficacy of excellent and good was achieved in 26 patients(74.3%),of which the excellent and good rate was 75.0(9/12)in patients with incomplete resection of epileptic lesions,100.0%(10/10)in patients with tumor recurrence,100.0%(2/2)in patients with wrong location,and 45.5%(5/11)in patients with unknown causes.Conclusions After the failure of the first operation for drug refractory epilepsy,a good prognosis can be obtained by comprehensively evaluating the cause of failure and selecting the appropriate surgical treatment according to the causes of failure.However,reoperation should be carefully considered in patients with unidentified causes for the first operation.

关 键 词：药物难治性癫痫 再次手术 首次手术 失败原因 疗效 

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]