联合手术方法治疗顽固性癫痫的探讨

The comprehensive surgical treatment intractable epilepsy

目的 研究将几种手术方式联合应用治疗顽固性癫痫的疗效。方法 新桥医院神经外科手术治疗癫痫123例,其中对50例顽固性癫痫病人在显微镜下采用几种术式结合的方法手术。16例行额颞开颅,额部过中线1cm,胼胝体前部切开+颞前叶+海马切除+额叶切除+多处软膜下横切术;10例行额颞枕开颅,萎缩皮质切除+颞叶切除+胼胝体前部切除+选择性海马切除+多处软膜下横切术;17例颞叶前部+海马切除+皮质多处软膜下横切;7例行颞叶切除+海马切除+选择性皮质多处软膜下横切。术后随访2-3年。结果 22例(44%)癫痫发作完全消失;18例(36%)癫痫发作显著减少,效果良好;7例(14%)疗效差;无明显改善3例(6%),手术总有效率达80.0%。结论 选择适当的手术方式治疗顽固性癫痫,可以取得最佳的治疗效果。

Objective To study the therapeutic effect of multiple operations in the treatment of intractable epilepsy.Methods 50 suizure patients were surgical treated in Xing Qiao Hospital, and underwent combined comprehensive operations.16 patients underwent anterior callosotomy combined with anterior temporal lobectomy, hippocampectomy and multiple subpial transaction,10 occipital lobe resection combined with anterior callosotomy, hippocampectomy and multiple subpial transaction,17 anterior temporal lobectomy, hippocampectomy and multiple subpial transaction. 7 temporal lobectomy, hippocampectomy and multiple subpial transaction. The outcomes of 50 patients in the following up 2-3 years were defined.Results Excellent 22cases(44%),good 18 cases (36%);moderate 7 cases (14%) and poor 3 cases(6%).The effective rate was 80%.Conclusion Comprehensive surgical management is an effective approach for treatment of refractory epilepsy.