局灶性皮质发育不良患者手术预后分析

发布时间：2018-07-28 11:29

【摘要】：目的:探讨局灶性皮质发育患者手术效果及预后影响因素。方法:收集2014年1月1日至2014年12月31日期间于广东三九脑科医院经手术治疗的局灶性皮质发育不良(Focal cortical dysplasia,FCD)患者,随访6~16月,根据Engel分级将患者分为预后好组(Engel I级)和预后差组(Engel II-IV级),分析比较两组患者的临床表现、检查结果、病理分类等临床资料的差异。结果:共102例患者,男65例(63.7%),女37例(36.3%),起病年龄2月-45岁,平均10.3岁,手术年龄3岁-47岁,平均21.21岁,均有癫痫发作,预后好组83例(81.4%),预后差组19例(18.6%)。预后好组起病年龄小于3岁例数占14.5%,出现智力减退例数比例为45.2%,术前脑电图非局灶性痫样放电率59.8%,磁共振(MRI)阴性率36.1%,磁共振定位与脑电图定位不一致率32.5%,术后脑电图痫样放电率49.4%。预后差组分别为36.8%、72.2%、89.5%、68.4%、94.1%、89.5%。预后好组操作智商(Performance intelligence quotient,PIQ)平均分为89.4分,预后差组为65.80分。两组间比较差异均有统计学意义(P0.05)。结论:局灶性皮质发育不良患者手术预后总体较好,起病年龄小于3岁、术前出现智力减退、操作智商得分低、术前脑电图非局灶性痫样放电、MRI阴性、磁共振与脑电图定位不一致、术后脑电图痫样放电可能为手术预后不良的危险因素。
[Abstract]:Objective: to investigate the operative effect and prognostic factors in patients with focal cortical development. Methods: patients with focal cortical dysplasia (Focal cortical dysplasia FCD) were collected from January 1, 2014 to December 31, 2014 in Sanjiu brain Hospital of Guangdong, and were followed up for 6 ~ 16 months. According to the Engel grade, the patients were divided into good prognosis group (Engel I grade) and poor prognosis group (Engel II-IV grade). The differences of clinical manifestations, examination results and pathological classification between the two groups were analyzed and compared. Results: there were 102 patients, 65 males (63.7%) and 37 females (36.3%). The onset age was from 2 months to 45 years old (mean 10.3 years), the operative age was 3 to 47 years old (mean 21.21 years). All patients had seizures. 83 cases (81.4%) had good prognosis and 19 cases (18.6%) had poor prognosis. In the group with good prognosis, the onset age was less than 3 years old, the incidence of mental retardation was 45.2%, the rate of non-focal epileptiform discharge was 59.8%, the negative rate of magnetic resonance (MRI) was 36.1%, the rate of mismatch between magnetic resonance localization and EEG location was 32.5%. The epileptiform discharge rate was 49.4%. The prognosis of the poor group was 36.8% and 72.2% and 89.5%, 68.4% and 94.1% respectively. The average score of (Performance intelligence quotient IQ was 89.4 in the good prognosis group and 65.80 in the poor prognosis group. The differences between the two groups were statistically significant (P0.05). Conclusion: the prognosis of the patients with focal cortical dysplasia is good, the onset age is less than 3 years old, the preoperative intelligence is decreased, the score of operational intelligence is low, and the preoperative EEG is negative for non-focal epileptiform discharges. MRI and EEG were different in localization. EEG epileptiform discharges may be the risk factors of poor prognosis after operation.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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