合并癫痫的胶质瘤手术后癫痫疗效分析

发布时间：2018-03-14 01:19

本文选题：神经胶质瘤　切入点：癫痫　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：总结合并癫痫的幕上胶质瘤开颅手术的经验与治疗结果；提供术前癫痫灶定位方法；探讨颅内幕上胶质瘤合并癫痫的发病机理及致痫因素；讨论以癫痫为首发症状的胶质瘤手术治疗效果，为患者提供一个有效的治疗方案。方法：通过随访2008年3月～2010年3月经手术治疗合并癫痫的幕上胶质瘤患者160例（病理证实）,分析其临床资料，采用SPSS统计软件，对并发癫痫的有统计学意义的筛选变量进行Logistic多元回归分析。分析年龄、性别、主要症状、病程、癫痫病史、阳性体征、病变部位、采取手术入路、术中血管损伤、皮质牵拉、术后脑组织水肿、病理结果、病变复发、放射治疗、术中皮层是否电灼和肿瘤切除程度等可能的影响因素为自变量，癫痫发作为因变量。术前除常规行头颅CT及MRI检查，还进行了常规脑电图检查及长程同步视频脑电图检查。分析肿瘤切除程度，术中处理致痫灶的方式、方法对癫痫控制程度及预后的影响。癫痫预后按Engel分类标准进行术后疗效评价：I级96例：癫痫发作消失，除外术后早期的癫痫发作；II级36例：癫痫发作极少或几乎消失；Ⅲ级16例：值得的改善（癫痫频率减少90%）；Ⅳ级12例：改善不明显。结果：肿瘤全切除128例中有96例（81%）在术中皮层脑电图（ECoG）监测下手术切除，癫痫完全消失；而不完全切除的32例中仅有8例（54%）癫痫发作完全消失。术中肿瘤切除的程度与预后癫痫发作有统计学意义（P=0.040）；术前每天癫痫发作＜1次者为86%（91/128），，而每天都发作≥1次者为56%（17/32），癫痫发作频率与癫痫预后有统计学意义（P=0.048）；单纯肿瘤切除的56例中术后未发生癫痫38例（54%），而肿瘤切除加MST的90例中有72例术后癫痫消失（82%）。将肿瘤全切和次全切术中是否处理致痫灶分为两组，针对癫痫控制满意率进行比较，差异有统计学意义（P0.05）。单纯肿瘤切除，全切与次全切预后癫痫控制满意率比较，差异有统计学意义（P0.01）。而在术中均处理致痫灶情况下，将肿瘤全切和次全切与部分切除者进行癫痫控制满意率比较，差异无统计学意义（P＞0.05，见表4）。结论：开颅手术是治疗胶质瘤合并癫痫的一种有效方法，术前致痫灶的准确定位是治疗关键。术前详细询问癫痫患者的病史，分析伴随的临床症状，进行全面系统的体格检查，以及影像学（CT、MRI等）和实验室检查，明确病因诊断对临床治疗起到积极作用。并发癫痫的胶质瘤患者，切除病灶和控制癫痫同等重要。对于手术治疗合并癫痫的胶质瘤患者，要求术中全切肿瘤，同时根据术中皮质脑电监测（ECOG）彻底处理致痫灶。术前致痫灶的准确定位、选择合适的手术入路和手术方法；术中进行病灶及致痫灶的彻底处理是获得理想预后的有效途径。术前癫痫病史长短、癫痫发作的频次、肿瘤大小、瘤周脑组织水肿程度，术中手术入路、肿瘤切除程度和皮层是否电灼及术后病理级别、脑组织水肿、肿瘤复发等因素与癫痫发作密切相关，对患者预后生活质量有直接影响。术后癫痫发作对患者的神经功能康复和日常生活质量都有很大影响。另外借助心理医生的健康指导教育可以改善患者术后的焦虑、抑郁等情绪，促进身心健康，进而提高生活质量。
[Abstract]:Objective: To summarize the epileptic supratemtorium glioma craniotomy experience and treatment results; provide preoperative localization of epileptic foci; of supratentorial gliomas with the pathogenesis of epilepsy and epileptogenic factors; to discuss the effect of surgical treatment for glioma epilepsy symptoms, provide an effective treatment regimen for patients.
Methods: through follow-up from March 2008 to 2010 3 menstrual surgical treatment of epilepsy with supratentorial gliomas were 160 cases (Pathology), analysis of the clinical data, using SPSS statistical software, screening variables on epilepsy have statistical significance in the multivariate Logistic regression analysis. The analysis of age, gender, course of disease, the main symptoms of epilepsy the history, positive signs, lesion, surgical approach, vascular injury, cortical stretch, brain edema, pathological results, disease recurrence, radiotherapy, intraoperative cortical electrocautery and whether the factors affect the tumor resection extent possible as independent variables, epilepsy as the dependent variable. In addition to the preoperative routine head CT and MRI examination, also conducted a routine EEG examination and long-range synchronization of video EEG analysis. The extent of tumor resection, intraoperative treatment of epileptogenic foci, method of seizure control extent and prognosis Effect of prognosis of the epilepsy surgery. According to Engel criteria for evaluating the effect of 96 cases of I grade: seizures disappeared, except for early postoperative seizure; 36 cases of grade II: seizures little or almost disappeared; 16 cases of grade III: worthwhile improvement (90% reduction of seizure frequency) 12 cases; grade IV: improve is not obvious.
Results: total resection in 128 cases, 96 cases (81%) in the intraoperative electrocorticography (ECoG) monitoring in surgical resection, epilepsy completely disappeared; without complete resection in 32 cases, only 8 cases (54%) seizures disappeared. Intraoperative epilepsy seizure degree and prognosis of tumor resection was statistically significant (P=0.040); preoperative seizures < 1 times every day for 86% (91/128), and every day more than 1 times for 56% episodes (17/32), the frequency of epileptic seizures and seizure outcomes were statistically significant (P=0.048); 38 cases of epilepsy occurred in 56 cases, simple tumor resection after operation (54%), and tumor resection plus MST 90 cases in 72 cases of postoperative epilepsy disappeared (82%). The total resection and subtotal resection of the tumor is treatment of the epileptogenic foci were divided into two groups according to seizure control satisfaction rate were compared, the difference was statistically significant (P0.05). Simple tumor resection, total resection and subtotal prognosis satisfactory seizure control rate The difference was statistically significant (P0.01). However, there was no statistically significant difference in the satisfaction rate of epileptic control between total resection and subtotal resection and partial resection for all epileptogenic foci. (P > 0.05, see Table 4).
Conclusion: craniotomy is an effective method for treatment of gliomas with epilepsy, accurate preoperative localization of epileptogenic foci is the key point of the treatment. The preoperative epilepsy patients asked in detail about the history, analysis of the clinical symptoms associated with, to conduct a comprehensive physical examination system and imaging (CT, MRI) and laboratory examination, clear etiological diagnosis of positive effect on the clinical treatment of glioma. Patients with epilepsy, resection of the lesion and control of epilepsy are equally important. For glioma surgical treatment of patients with epilepsy, requiring complete tumor resection, and according to the intraoperative monitoring of cortical electroencephalogram (ECOG) a thorough treatment of the epileptogenic focus. Accurate preoperative localization by the epileptogenic focus, select the appropriate surgical approach and surgical methods; thorough treatment of lesion and the epileptogenic foci in operation is an effective way to obtain ideal prognosis. Preoperative epilepsy duration, seizure frequency, tumor size, tumor Peripheral brain tissue edema, intraoperative surgical approach, the extent of tumor resection and whether cortical electrocautery and postoperative pathological grade, brain edema, tumor recurrence and factors of epilepsy are closely related, have a direct impact on the quality of life. The prognosis of patients with postoperative seizures have great influence on neural functional recovery of patients and the quality of daily life. The health guidance education by means of psychological doctor can improve the postoperative patients with anxiety, depression, and promote physical and mental health, and to improve the quality of life.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.41

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