难治性颞叶癫痫显微外科手术疗效分析(附27例报道)

The clinical effect of microsurgical technique in patients with temporal lobe epilepsy(A report of 27 cases)

目的探讨难治性颞叶癫痫的术前评估、标准前颞叶切除术的实际应用及其疗效的影响因素。方法在显微镜下对27例难治性颞叶癫痫患者进行标准前颞叶切除术治疗。部分患者同时行皮质热灼术。术后均随访1年以上,根据手术预后按Engel’s分级情况将患者分为满意组(患者分级为Ⅰ级)与非满意组(患者分级为Ⅱ级以上),并对两组患者术前发作形式、影像学改变和脑电图监测等情况进行回顾分析。结果本组27例患者均无严重并发症发生。术后疗效Engel’s分级Ⅰ级20例(74.1%),Ⅱ级2例(7.4%),Ⅲ级4例(14.8%),Ⅳ级1例(3.7%),其中满意组患者20例,非满意组患者7例。两组间比较,满意组术前无继发性强直阵挛发作、影像学无双重改变和发作间期刺激区(IZ)局限于单侧颞区的患者比例高(均P<0.05)。结论手术前充分认识发作形式、影像学检查结果和脑电图特点,有助于提高标准前颞叶切除术的疗效。

Objective To investigate the presurgical evaluation of the temporal lobe epilepsy （TLE）, the practical application of standard temporalobectomy and to discuss factors that effected therapeutic efficacy. Methods Twenty-seven cases of TLE who underwent standard temporalobectomy in author＇ s hospital were collected. All patients were divided into satisfactory or unsatisfactory group according to outcomes after operation. The pattern of the pre-operative seizure, imaging characteristics and features of electroencephalogram were retrospectively studied and analyzed statistically. Results Twenty-seven cases did not have serious complications. According to Engel＇ s classification, 20 cases （74.1~） achieved outcome of class I , 2 cases （7.4~） achieved outcome of class II , 4 cases （14.80//00） had outcome of class I]] , 1 case （3.7~/00） had outcome of class IV. Class I was satisfactory; class II , IlI and IV were unsatisfactory. The occurrence rates of tonic- clonic seizure, double imaging changes and nonfocal irritative zone, were higher in the unsatisfactory group than those in the satisfactory group （P^0.05）. Conclusions The strict preoperative evaluation, careful presurgical studies of patterns of the preoperative seizure, imaging characteristics and features of video electroencephalogram were very helpful and prerequisite for improving the surgical outcome.