外伤性癫痫长期手术疗效与安全性分析  

Analysis of long-term surgical outcome and safety in patients with post-traumatic epilepsy

作　　者：李焕发 刘永 孟强 武昊 董珊 刘晓芳[1] 张华[1] LI Huanfa;LIU Yong;MENG Qiang(Department of Neurosurgery,the First Affiliated Hospital of Xi′an JiaoTong University,Xi′an 710061,China)

机构地区：[1]西安交通大学第一附属医院神经外科,陕西西安710061

出　　处：《中风与神经疾病杂志》2023年第6期518-521,共4页Journal of Apoplexy and Nervous Diseases

基　　金：陕西省创新能力支撑计划(2021LCZX-01);陕西省自然科学基础研究计划(2022JQ-809)。

摘　　要：目的探讨外伤性癫痫(post-traumatic epilepsy,PTE)患者进行切除性手术治疗的长期发作控制疗效和安全性。方法连续性纳入我中心2014年1月至2020年12月进行切除性手术治疗的PTE患者,回顾性分析其人口学特征及临床资料,采用单因素分析和多因素Logistic回归分析来确定术后疗效的潜在预测因素,并记录和随访手术相关并发症。结果共纳入104例PTE患者,术后平均随访(68.7±23.2)个月(20~103个月),术后疗效按Engel分级为:60.6%(63/104)为EngelⅠ级;39.4%(41/104)为EngelⅡ~Ⅳ级。单因素分析显示手术时年龄和手术侧别与术后疗效相关,多因素分析显示只有手术侧别是术后疗效的独立预测因素(OR=2.944,95%CI 1.283~6.753,P=0.011),手术侧别为右侧时术后无发作(EngelⅠ级)率是左侧的2.9倍。29.8%(31/104)的患者出现了不同程度的手术相关并发症,包括皮下或硬膜下积液20例;脑水肿3例;脑出血2例;脑积水合并切口感染1例;神经功能障碍5例,其中4例在随访期内完全恢复。结论PTE患者通过综合的术前评估并进行切除性手术治疗,其手术后长期疗效和安全性总体较好,且手术侧别为右侧时可预测好的术后疗效。Objective To investigate the long-term surgical outcome and safety of resective surgical treatment in patients with post-traumatic epilepsy(PTE).Methods Patients with PTE who underwent resective surgery from January 2014 to December 2020 at our center were consecutively included,and their demographic characteristics and clinical data were retrospectively analyzed.Univariate analysis and multifactor Logistic regression analysis were used to identify potential predictors of postoperative outcome,and surgery-related complications were documented and followed-up.Results A total of 104 patients with PTE were included.The postoperative outcomes were graded by Engel class:60.6%(63/104)as Engel classⅠand 39.4%(41/104)as Engel classⅡ-Ⅳwith a mean follow-up of(68.7±23.2)months(20-103 months).Univariate analysis showed that age at the time of surgery and surgical side were associated with postoperative outcome,while multivariate analysis showed that only surgical side was an independent predictor of postoperative outcome(OR=2.944,95%CI 1.283-6.753,P=0.011),with 2.9 times the seizure-free(Engel classⅠ)rate when the surgical side was right-sided compared with left-sided.29.8%(31/104)of patients had varying degrees of surgery-related complications,including 20 cases of subcutaneous or subdural effusion;3 cases of cerebral edema;2 cases of cerebral hemorrhage;1 case of hydrocephalus combined with incisional infection;and 5 cases of neurological deficits,4 of which recovered completely during the follow-up period.Conclusion PTE patients treated with resective surgery after comprehensive preoperative evaluation had good long-term surgical outcomes and safety,and good postoperative outcomes were predicted when the surgical side was right-sided.

关 键 词：外伤性癫痫 手术疗效 预测因素 安全性 

分 类 号：R742.1[医药卫生—神经病学与精神病学]