局灶性皮质发育不良致药物难治性癫痫的手术预后及相关影响因素分析
发布时间：2018-11-24 21:23
【摘要】：目的:本研究旨在探讨局灶性皮质发育不良(FCD)所导致的药物难治性癫痫的手术预后与性别、FCD病理分型、MRI检查结果、病灶位置是否位于颞叶、患者手术年龄、手术是否全切致痫灶之间的关系。为指导FCD所致的药物难治性癫痫患者的手术预后提供理论依据。方法:回顾性分析2007年5月至2015年11月于首都医科大学宣武医院神经外科收治的97例病理确诊为局灶性皮质发育不良的药物难治性癫痫患者,回顾性分析其97例患者的癫痫手术预后情况,并分析患者性别、MRI检查结果、致痫灶所在脑叶、手术年龄、是否全切致痫灶及FCD病理分型与癫痫手术预后之间的关系。结果:97例患者平均随访时间为59.18±28.62个月(15-119个月,中位随访时间为65个月)。其中男性61例(62.89%),女性36例(37.11%)。术后Engel I级的患者60例(61.86%),Engle II级11例(11.34%),Engle III级16例(16.49%),Engle IV级10例(10.31%)。将术后Engel I级的患者视为预后良好,术后Engel II-IV级的患者视为预后较差。将这些患者的MRI检查结果分为MRI阳性(即影像学检查提示明确病灶)和MRI阴性(即影像学检查未能发现明确病灶);病灶位置分为位于颞叶和位于颞叶以外;患者手术年龄分为大于等于18岁和小于18岁;手术切除范围分为全切致痫灶和未全切致痫灶;FCD病理分型依据2011年国际抗癫痫联盟(International League Against Epilepsy,ILAE)最新分类方法分为FCD I型、II型和III型。将上述各因素分别与患者手术预后结果进行统计学分析。最终得出:FCD致药物难治性癫痫患者的手术预后与MRI检查结果、患者手术年龄、是否全切致痫灶相关,而性别、FCD病理分型及病灶是否位于颞叶与手术预后无统计学差异。以患者术后预后良好为阳性时间,将97例患者的预后结果进行生存分析,可知FCD所致的药物难治性癫痫患者术后5年癫痫预后良好率约为59%。结论:FCD致药物难治性癫痫患者的性别、FCD病理分型及病灶是否位于颞叶与手术预后无统计学差异。患者手术年龄小于18岁、MRI检查结果阳性及全切致痫灶的患者术后预后良好。
[Abstract]:Objective: to investigate the prognosis and sex of drug refractory epilepsy caused by focal cortical dysplasia (FCD), the pathological classification of FCD, the results of MRI, the location of the lesion in the temporal lobe, and the operative age of the patients. The relationship between surgical resection and epileptic foci. To provide a theoretical basis for the surgical prognosis of patients with drug-resistant epilepsy caused by FCD. Methods: from May 2007 to November 2015, 97 patients with intractable drug epilepsy diagnosed pathologically as focal cortical dysplasia were retrospectively analyzed in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University. The prognosis of epileptic surgery in 97 patients was analyzed retrospectively, and the relationship between the prognosis of epileptic surgery and sex, the results of MRI, the location of epileptogenic foci, the age of operation, whether the epileptogenic foci were completely removed, and the pathological classification of FCD were analyzed. Results: the mean follow-up time of 97 patients was 59.18 卤28.62 months (15-119 months, median 65 months). There were 61 males (62.89%) and 36 females (37.11%). There were 60 cases (61.86%) of), Engle II grade I (11 cases of), Engle II grade) (11.34% of), Engle III grade 16 cases (16.49%) of), Engle IV grade 10 cases (10.31%). The patients with Engel grade I after operation were regarded as good prognosis, and those with Engel II-IV grade after operation were regarded as poor prognosis. The results of MRI examination in these patients were divided into MRI positive (that is, imaging showed definite lesion) and MRI negative (that is, no clear focus was found by imaging examination), the location of lesion was divided into temporal lobe and outside temporal lobe. The operative age of the patients was greater than 18 years old and less than 18 years old, the range of surgical resection was divided into total epileptic foci and incomplete epileptic foci. The pathological classification of FCD was classified into FCD I, II and III according to the latest classification of (International League Against Epilepsy,ILAE in 2011. The above factors were statistically analyzed with the outcome of operation. It is concluded that the prognosis of patients with drug-resistant epilepsy caused by FCD is related to the results of MRI examination, the age of operation, whether the epileptogenic foci are completely incised, but there is no significant difference in sex, pathological classification of FCD and whether the focus is located in temporal lobe or not. According to the positive time of good prognosis after operation, 97 patients' survival analysis showed that the good prognosis rate of patients with drug-resistant epilepsy caused by FCD was about 59g after 5 years. Conclusion: there is no significant difference in sex, FCD pathological classification and prognosis between patients with drug-resistant epilepsy induced by FCD. The operative age was less than 18 years old, and the prognosis was good in the patients with positive MRI findings and total resection of epileptogenic foci.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1
本文编号：2355112
[Abstract]:Objective: to investigate the prognosis and sex of drug refractory epilepsy caused by focal cortical dysplasia (FCD), the pathological classification of FCD, the results of MRI, the location of the lesion in the temporal lobe, and the operative age of the patients. The relationship between surgical resection and epileptic foci. To provide a theoretical basis for the surgical prognosis of patients with drug-resistant epilepsy caused by FCD. Methods: from May 2007 to November 2015, 97 patients with intractable drug epilepsy diagnosed pathologically as focal cortical dysplasia were retrospectively analyzed in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University. The prognosis of epileptic surgery in 97 patients was analyzed retrospectively, and the relationship between the prognosis of epileptic surgery and sex, the results of MRI, the location of epileptogenic foci, the age of operation, whether the epileptogenic foci were completely removed, and the pathological classification of FCD were analyzed. Results: the mean follow-up time of 97 patients was 59.18 卤28.62 months (15-119 months, median 65 months). There were 61 males (62.89%) and 36 females (37.11%). There were 60 cases (61.86%) of), Engle II grade I (11 cases of), Engle II grade) (11.34% of), Engle III grade 16 cases (16.49%) of), Engle IV grade 10 cases (10.31%). The patients with Engel grade I after operation were regarded as good prognosis, and those with Engel II-IV grade after operation were regarded as poor prognosis. The results of MRI examination in these patients were divided into MRI positive (that is, imaging showed definite lesion) and MRI negative (that is, no clear focus was found by imaging examination), the location of lesion was divided into temporal lobe and outside temporal lobe. The operative age of the patients was greater than 18 years old and less than 18 years old, the range of surgical resection was divided into total epileptic foci and incomplete epileptic foci. The pathological classification of FCD was classified into FCD I, II and III according to the latest classification of (International League Against Epilepsy,ILAE in 2011. The above factors were statistically analyzed with the outcome of operation. It is concluded that the prognosis of patients with drug-resistant epilepsy caused by FCD is related to the results of MRI examination, the age of operation, whether the epileptogenic foci are completely incised, but there is no significant difference in sex, pathological classification of FCD and whether the focus is located in temporal lobe or not. According to the positive time of good prognosis after operation, 97 patients' survival analysis showed that the good prognosis rate of patients with drug-resistant epilepsy caused by FCD was about 59g after 5 years. Conclusion: there is no significant difference in sex, FCD pathological classification and prognosis between patients with drug-resistant epilepsy induced by FCD. The operative age was less than 18 years old, and the prognosis was good in the patients with positive MRI findings and total resection of epileptogenic foci.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1
【参考文献】
相关期刊论文 前2条
1 孙恒;姜磊;买买提江;石鑫;冯兆海;郝玉军;;局灶性脑皮质发育不良致顽固性癫痫的手术预后及其相关影响因素分析[J];中华神经外科杂志;2015年03期
2 董长征;赵文清;李文玲;岳向勇;郭韬;杜亚丽;康进生;武江;梁传栋;;局灶性脑皮质发育不良致难治性癫痫病理分型和手术疗效分析[J];中华神经外科杂志;2010年03期
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