胼胝体切开治疗药物难治性癫痫105例分析

Anterior corpus callosotomy in patients with intractable epilepsy: a retrospective analysis of 105 patients

目的探讨胼胝体切开术治疗药物难治性癫痫的适应证、手术方法、有效性及安全性。方法 1999年1月至2010年8月单纯采用胼胝体切开术治疗105例药物难治性癫痫患者,发作类型以容易致残的全身性强直一阵挛发作（48例）、全身性强直发作（32例）或失张力发作（25例）为主。其中58例行胼胝体前2/3切开,47例行前3/4切开。结果术后随访13~150个月,所有患者术后继续正规服用抗癫痫药物,13例（12.4%）患者术后发作消失,59例（56.2%）发作频率减少大于75%,22例（21.0%）发作频率减少50%~75%,9例（8.6%）无明显改善,2例（1.9%）加重。围手术期没有死亡病例,手术并发症较轻,且多为一过性。结论对于无法行致痫灶切除术的药物难治性癫痫患者,胼胝体切开术能有效减少癫痫全身性发作的频率和严重程度。

Objective To explore the indication, extent, efficacy and safety of anterior corpus callosotomy （CC） in the patients with intractable epilepsy. Methods The clinical data of 105 patients with intractable epilepsy who underwent an anterior CC from January, 1999 to August, 2010 were analyzed retrospectively. Of 105 patients with intractable epilepsy, 48 suffered from generalized tonic-clonic seizures, 32 generalized tonic seizures and 25 atonic seizures before the surgery. Fifty-eight patients underwent anterior two-thirds CC, and 47 anterior three-fourths CC. Results The following up from 13 to 150 months after the surgery showed that the seizure disappeared in 13 patients, the seizures frequency decreased by more than 75% in 59, the seizures frequency decreased by 50% ~75% in 22, the seizure were unchanged in 9 and the seizures worsened in 2. The effects of anterior CC on the several type seizures, especially on the atonic seizures and generalized tonic-clonic seizure, were good. There were no severe postoperative complications and no patients died in these patients. Conclusion The severity and frequency of the seizures can be significantly decreased by the anterior CC in the patients with intractable epilepsy who can not be treated by removal of the epileptogenic foci.