不同术式选择对颞叶癫痫患者术后记忆功能影响的初步探讨

Preliminary investigation on memory outcomes following selective amygdalohippocampectomy versus anterior temporal lobectomy for temporal lobe epilepsy and hippocampal sclerosis

目的探讨不同术式选择对颞叶癫痫患者术后记忆功能的影响。方法 2009～2013年共248例海马硬化性颞叶癫痫患者在我院接受手术治疗,其中83例行标准前颞叶切除术（anterior temporal lobectomy,ATL）,165例行选择性海马杏仁核切除术（selective amygdalohippocampectomy,SAH）。患者在术前、术后3个月及术后两年分别接受临床记忆功能评估。结果 ATL组和SAH组优势半球侧手术的患者临床记忆商数（memory quotient,MQ）在术后3个月（74.5±16.2,75.6±19.5）均有明显下降（P〈0.05）,术后两年（75.1±14.1,76.1±17.6）略有恢复但仍然显著低于术前（82.9±15.8,83.2±21.2）（P〈0.05）,其中SAH组术后3个月及术后两年相较术前MQ的减低程度都小于ATL组（7.6 vs.8.4;7.1 vs.7.8）;ATL组和SAH组非优势半球侧手术的患者术后3个月的MQ（87.2±15.1,88.1±16.9）均高于术前（85.5±13.5,85.3±19.7）,但无统计学意义,至术后两年时,两组患者的MQ（92.8±12.7,93.7±17.1）对比术前都有了显著的改善（P〈0.05）,其中SAH组患者的改善幅度较ATL组略大（8.4 vs.7.3）。结论相比于ATL,SAH可能更有利于保护海马硬化性颞叶癫痫患者的术后记忆功能。

Objective To investigate the different memory outcomes in temporal lobe epilepsy patients underwent different surgical approaches.Methods Two hundred forty-eight patients with temporal lobe epilepsy and hippocampal scle-rosis underwent standard anterior temporal lobectomy （ ATL, n=83 ） or selective amygdalohippocampectomy （ SAH, n=165） from 2009 to 2013.All the patients underwent clinical memory function assessment before surgery, 3 months and 2 years after surgery respectively.Results The memory quotient （ MQ） of patients who underwent brain surgery in the domi-nant hemisphere significantly decreased 3 months after surgery （74.5 ±16.2, 75.6 ±19.5） compared to presurgery MQ （82.9 ±15.8, 83.2 ±21.2） in both ATL and SAH groups （P〈 0.05）.Although MQ was slightly recovered at 2 years af-ter surgery, MQ （75.1 ±14.1, 76.1 ±17.6） was still significantly lower compared with presurgery MQ （P〈 0.05）.A-mong this, both the decrease extent of the MQ 3 months after surgery and 2 years after surgery were smaller in the SAH group than in the ATL group （7.6 vs.8.4;7.1 vs.7.8）.The MQ of patients who underwent brain surgery in the non-dominant hemisphere （either ATL or SAH ） increased slightly 3 months after surgery （87.2 ±15.1, 88.1 ±16.9） com-pared to presurgery MQ （85.5 ±13.5, 85.3 ±19.7） although the difference was not statistically significant.The MQ of these two groups improved significantly 2 years after surgery （92.8 ±12.7, 93.7 ±17.1）（P〈 0.05）.The improvement extent of the MQ was larger in the SAH group than in the ATL group （8.4 vs.7.3）.Conclusions SAH may be better than ATL in the maintenance of memory function in patients with temporal lobe epilepsy and hippocampal sclerosis.