药物难治性半球病变性癫痫手术治疗效果及手术方式比较的回顾性研究

发布时间：2018-10-30 14:32

【摘要】：目的探讨药物难治性半球病变性癫痫手术疗效,并对功能性大脑半球切除术和大脑半球离断术两种手术方式作比较。方法回顾性分析2005年至2017年在我科手术治疗的25例药物难治性半球病变性癫痫患者,根据所行手术方式分为功能性大脑半球切除术组(FH)15例,大脑半球离断术组(H)10例,对手术时间、术中出血、围手术期并发症、术后癫痫控制、神经功能作回顾性研究。结果术后随访1~12年,平均随访5.28±2.91年。除去失访2例总的癫痫发作控制率为Engel Ia 19例(82.60%)、Engel Id 3例(13.04%)、Engel IIa 1例(4.36%)。在癫痫控制率上,FH组与H组比无差异(p0.05)。在手术时间上,FH组手术时间较H组长,在术中失血上,FH组高于H组,且上述差异均有统计学意义(p0.05)。结论大脑半球切除术是一种有效的难治性半球病变性癫痫治疗措施,术后不仅能有效控制癫痫发作,且部分患者神经功能还得到改善,而大脑半球离断术作为一种创伤更小、疗效相当的手术方式,值得推广。
[Abstract]:Objective to investigate the curative effect of drug-resistant hemispheric epilepsy and to compare the two operative methods: functional hemispherectomy and hemispheric amputation. Methods from 2005 to 2017, 25 patients with drug-resistant hemispheric lesion epilepsy who were treated by our department from 2005 to 2017 were retrospectively analyzed. According to the operative methods, 15 patients were divided into functional hemispheric resection group (FH) group) and functional cerebral hemispheric resection group (FH) group). 10 cases of (H) were treated with hemispheric hemispheres. The operative time, intraoperative bleeding, perioperative complications, postoperative epilepsy control and neurological function were studied retrospectively. Results the postoperative follow-up ranged from 1 to 12 years (mean 5.28 卤2.91 years). The total seizure control rate was Engel Ia in 19 (82.60%), Engel Id in 3 (13.04%), Engel IIa in 1 (4.36%). There was no difference in epileptic control rate between FH group and H group (p0.05). The operative time of FH group was higher than that of H group, and the blood loss in FH group was higher than that in H group (p0.05). Conclusion Hemispheres resection is an effective treatment for intractable hemispheric epilepsy. It can not only effectively control epileptic seizures, but also improve the neurological function of some patients. The operative method with similar curative effect is worth popularizing.
【作者单位】：安徽医科大学解放军174临床学院;解放军第一七四医院神经医学中心;解放军第一七四医院麻醉科;
【基金】：南京军区医学科技创新课题(ZD26)
【分类号】：R651.1

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