难治性癫痫手术效果评判时限

The critical time for judging the outcome of the epilepsy surgery

目的 总结分析难治性癫痫手术效果，以及手术后效果趋于稳定的时限。方法 对120例难治性癫痫手术患者进行长期追踪随访，并依照Engel分级对患者术后效果进行分类；比较患者术后半年，1年和远期（1年半以上）随访疗效，观察术后达到EngelⅠ-Ⅱ疗效比例的变化。结果 120例难治性癫痫手术患者中，术后半年随访发现：61％术后无癫痫再发，18％术后仅有先兆发作，7％偶有痫性发作（半年中小于2次），痫性发作明显减少（痫性发作减少大于80％）为5％，手术效果不明显（痫性发作减少小于20％）占9％；术后1年随访发现：无癫痫再发为45％，术后仅有先兆为12％，术后偶有痫性发作为12％（1年中小于3次），痫性发作明显减少为13％，手术效果不明显为18％。最近的随访结果如下（随访1．5～3年，平均1．8年）：无癫痫再发占43％，仅有先兆占13％，术后偶有痫性发作占14％，痫性发作明显减少占13％，手术效果不明显占17％。半年期随访预后和1年期随访预后中达到EngelⅠ-Ⅱ的比例有明显差异（组间差异有统计学意义，P〈0．05），1年期随访预后与长期随访预后中达到EngelⅠ-Ⅱ的比例无明显差异（组间差异无统计学意义，P〉0．05）。结论 药物难治性癫痫术后半年期随访评判疗效不可靠，而1年期疗效预示术后长期效果。

Objective To analyze the long term results of refractory temporal lobe epilepsy surgery, and to evaluate the critical time for judging the outcomes. Methods Longitudinal follow up of 120 consecutive adult patients operated on for temporal lobe epilepsy, evaluate the outcomes following the Engel classification, and view the ratio of the Engel Ⅰ-Ⅱ outcomes in half an year,one year and long-term follow up. Results In the half an year following of the 120 postoperative patients：61% of them became seizure-free, 18% had only postoperative auras, and 7% had rare seizures on follow up （less than 2 times）, 5% benefit from the operation（more than 80% seizures been controlled）,9 % had unsatisfied outcomes （seizure been controlled less than 20%）. In one year follow up：45% of patients became seizure-free, 12% had only postoperative auras, and 12% had rare seizures on follow up （less than 3 times）, 13% benefit from the operation, 18% had unsatisfied outcomes. In long-term follow up（range 1.5-3 years, mean 1.8 years） ：43% of patients became seizure-free, 13% had only postoperative auras, and 14% had rare seizures on follow up, 13% benefit from the operation, 17% had unsatisfied outcomes. The ratio of the Engel Ⅰ-Ⅱ outcomes in half an year and one year following up has obvious difference（P〈0. 05）,the ratio of the Engel Ⅰ-Ⅱ outcomes in one year and long-term follow up has no statistic difference（P〉 0. 05）. Conclusion It is unreliable to judge the outcomes in the half an year＇s following. The one year following may predict the long-term out comes.