胼胝体切开联合皮层热灼术治疗难治性癫痫(附82例回顾分析)

Corpus callosotomy combined with purely electro-coagulation treat to intractable epilepsy-82 cases retrospective analysis

目的探讨胼胝体切开联合皮层热灼术治疗难治性癫痫的手术方式与治疗效果。方法82例难治性癫痫行胼胝体切开术治疗,其中18例行单纯胼胝体切开、33例行胼胝体切开＋致痫皮层低功率电凝热灼、31例行单侧致痫灶切除＋胼胝体切开＋致痫皮层低功率电凝热灼。术后随访6个月~2年。结果11例（13.4%）癫痫发作完全消失;41例（50%）癫痫发作次数显著减少;16例（19.5%）癫痫发作程度减轻;8例（9.8%）无明显改善;6例（7.3%）发作略有加重;无死亡病例。手术后疗效以Wilsion标准评判,优良率为83%。结论部分性发作的癫痫患者,最可靠的治疗方法是致痫灶的切除,但对于全面性发作的病人,其致痫区往往比较广泛而无法切除,胼胝体切开可以阻断两侧半球间痫样放电的传播,联合皮层热灼术可以减少发作频率、减轻发作程度和改变发作形式,提高治疗效果。

Objective To approach the feature of the case that corpus callosotomy treat with intractable epilepsy, and choose modus operandi. Methods 82 cases were operated with corpus callosotomy, 18 cases were operated with simple corpus callosotomy,33 cases were operated with corpus callosotomy combined with purely electro -- coagulation,31 cases were operated with Limit cut off of epileptogenic focus and corpus callosotomy combined with purely electro - coagulation. During 6-24 months follow -- up. Results 11 cases （13.4%） were free from seizure; significant reduction of seizure attack in41（50 % ）; 16 cases （19.5%） reduction of seizure attack; no change in 8 （9.8%） ; aggravation of seizure attack in 6 （7.3%） ;no death cases . To judge curative effect with Wilsion standard in postop, fineness rate is 83% ;The selection with case and modus operandi influence the result directly. Conclusion The most dependable surgical operation method for intractable epilepsy is Limit cut off of epileptogenic focus.. But for comprehensive the patient , it with the epileptogenic focus is usually more extensive but can＇t cut off, corpus callosotomy can stop two side hemisphere the epilepsitic electricity of dissemination, reduce to epileptic seizure frequency and ease to degree or change to shape. To make corpus callosotomy combined with purely electro -- coagulation according to clinical characteristicsandel ectroencephalogram characteristic cure effect a satisfaction.