药物难治性半球病变性癫痫手术治疗效果及手术方式比较的回顾性研究

Surgical outcome of medically intractable hemispheric epilepsy and clinical effect of functional hemispherectomy versus hemispherotomy:a retrospective analysis

目的探讨药物难治性半球病变性癫痫手术疗效,并对功能性大脑半球切除术和大脑半球离断术两种手术方式作比较。方法回顾性分析2005年至2017年在我科手术治疗的25例药物难治性半球病变性癫痫患者,根据所行手术方式分为功能性大脑半球切除术组(FH)15例,大脑半球离断术组(H)10例,对手术时间、术中出血、围手术期并发症、术后癫痫控制、神经功能作回顾性研究。结果术后随访1~12年,平均随访5.28±2.91年。除去失访2例总的癫痫发作控制率为Engel Ia 19例(82.60%)、Engel Id 3例(13.04%)、Engel IIa 1例(4.36%)。在癫痫控制率上,FH组与H组比无差异(p>0.05)。在手术时间上,FH组手术时间较H组长,在术中失血上,FH组高于H组,且上述差异均有统计学意义(p<0.05)。结论大脑半球切除术是一种有效的难治性半球病变性癫痫治疗措施,术后不仅能有效控制癫痫发作,且部分患者神经功能还得到改善,而大脑半球离断术作为一种创伤更小、疗效相当的手术方式,值得推广。

Objective To investigate the surgical outcome of medically intractable hemispheric epilepsy and the clinical effect of functional hemispherectomy （HF） versus hemispherotomy （H）.Methods A retrospective analysis was performed for the clinical data of 25 patients with medically intractable hemispheric epilepsy who underwent surgical treatment in our department from 2005 to 2017.According to the surgical procedure,these patients were divided into FH group with 15 patients and H group with 10 patients.The time of operation,intraoperative blood loss,perioperative complications,postoperative epilepsy control,and neurological function were retrospectively analyzed.Results The postoperative follow-up lasted for 1-12 years,and the mean follow-up time was 5.28 ± 2.91 years.Two patients were lost to follow-up,and among the other patients,19 （82.60%） had an Engel Ⅰa outcome,3 （13.04%） had an Engel Ⅰd outcome,and 1 （4.36%） had an Engel Ⅱa outcome.There was no significant difference in the control rate of epilepsy between the FH group and the H group （P 〉 0.05）.Compared with the H group,the FH group had a significantly longer time of operation and significantly higher intraoperative blood loss （P 〈 0.05）.Conclusions FH is an effective surgical procedure for the treatment of medically intractable hemispheric epilepsy and allows for a high epilepsy-free rate after surgery,and some patients may achieve improvements in neurological function.Hemispherotomy is an effective minimally invasive surgical procedure and holds promise for clinical application.