经颈部低位单切口迷走神经刺激治疗药物难治性癫痫的临床效果分析  

Clinical analysis of vagus nerve stimulation with low cervical single incision for the treatment of drug-resistant epilepsy

作　　者：和政 李超[2] 徐硕[2] 李保敏[3] 陈思[4] 姜彬 陈腾[2] 张红英 徐淑军[2] He Zheng;Li Chao;Xu Shuo;Li Baomin;Chen Si;Jiang Bin;Chen Teng;Zhang Hongying;Xu Shujun(Department of Neurosurgery,Qilu Hospital of Shandong University(Qingdao),Qingdao 266000,China;Department of Neurosurgery,Qilu Hospital of Shandong University,Jinan 250000,China;Department of Pediatrics,Qilu Hospital of Shandong University,Jinan 250000,China;Department of Neurology,Qilu Hospital of Shandong University,Jinan 250000,China)

机构地区：[1]山东大学齐鲁医院(青岛)神经外科,青岛266000 [2]山东大学齐鲁医院神经外科,济南250000 [3]山东大学齐鲁医院小儿内科,济南250000 [4]山东大学齐鲁医院神经内科,济南250000

出　　处：《中华神经外科杂志》2024年第2期132-136,共5页Chinese Journal of Neurosurgery

基　　金：青岛市神经系统罕见病临床医学研究中心(22-3-7-lczx-3-nsh);青岛市医疗卫生重点学科建设项目。

摘　　要：目的 探讨经颈部低位单切口迷走神经刺激(VNS)治疗药物难治性癫痫(DRE)的安全性和有效性.方法 回顾性分析山东大学齐鲁医院癫痫中心2016年6月至2022年5月收治的78例DRE患者的临床资料.其中,经颈部低位单切口行VNS 57例(单切口 VNS组),采用传统双切口行VNS 21例(双切口 VNS组).术后采用门诊或电话随访,根据癫痫发作的控制情况(包括有效率和无发作率)评估手术疗效.比较两组患者的基线特征、手术时长、术中出血量、手术疗效和术后并发症的发生情况.结果 单切口 VNS组与双切口 VNS组在年龄、性别、病程、癫痫发作类型、手术时长、术中出血量方面的差异均无统计学意义(均P>0.05).两组患者相比较,术后6、12、24个月的癫痫控制有效率(x^(2)=3.00)、无发作率(x^(2)=2.00)的差异均无统计学意义(均P>0.05).两组患者术后切口愈合不良或感染发生率的差异无统计学意义(P>0.05),但在一过性声音嘶哑[1.8%(1/57)对比 14.3%(3/21)]、咳嗽[3.5%(2/57)对比 19.0%(4/21)]的发生率方面,单切口 VNS 组均低于双切口 VNS组(均P<0.05).结论 经单切口行VNS与经双切口行VNS治疗DRE的手术疗效相当,但前者术后并发症的发生率更低,可作为一种可选择的VNS手术方式.ObjectiveTo explore the safety and effectiveness of vagus nerve stimulation(VNS)with low cervical single incision in the treatment of drug-refractory epilepsy(DRE).MethodsThe clinical data of 78 DRE patients admitted to the Epilepsy Center of Qilu Hospital of Shandong University from June 2016 to May 2022 were retrospectively analyzed.Among them,57 cases underwent VNS through a low cervical single incision(single-incision VNS group),and 21 cases underwent VNS using traditional double incisions(double-incision VNS group).Postoperative outpatient or telephone follow-up was used to evaluate the surgical efficacy based on the control of epileptic seizures(including responder rate and seizure-free rate).The baseline characteristics,operation time,intraoperative blood loss,surgical efficacy and occurrence of postoperative complications were compared between the two groups of patients.ResultsThere were no statistically significant differences between the single-incision VNS group and the double-incision VNS group in terms of age,gender,disease duration,epileptic seizure type,operation duration,or intraoperative blood loss(all P>0.05).Comparing the two groups of patients,there were no statistically significant differences in the responder rate(χ^(2)=3.00)or seizure-free rate(χ^(2)=2.00)at 6,12,or 24 months after surgery(all P>0.05).There was no statistically significant difference in the incidence of postoperative infection or poor healing of incision between the two groups(P>0.05),but the incidence of transient hoarseness[1.8%(1/57)vs.14.3%(3/21)]or cough[3.5%(2/57)vs.19.0%(4/21)]was lower in the single-incision VNS group than in the double-incision group(both P<0.05).ConclusionThe surgical efficacy of single-incision VNS and double-incision VNS in the treatment of DRE are similar,but the former has a lower incidence of postoperative complications and can be used as an alternative VNS surgical method.

关 键 词：耐药性癫痫 迷走神经刺激术 治疗结果 手术后并发症 单切口 

分 类 号：R651.12[医药卫生—外科学]