大脑半球切除术和功能性大脑半球切除术治疗儿童难治性癫痫的效果对比

The observation of curative effect of the anatomical and functional hemispherectomy in the treatment of refractory epilepsy in children

【目的】旨在探讨大脑半球切除术和功能性大脑半球切除术在治疗儿童难治性癫痫效果方面是否具有差异,指导手术方式的选择。【方法】回顾性分析宣武医院2013年1月至2018年1月收治的大脑半球切除术及功能性大脑半球切除手术病例的病历资料。全组共14例,其中男11例,女3例,首次诊断为癫痫时年龄从1岁2个月~3岁4个月,平均2岁1个月,诊断为难治性癫痫的年龄从2岁8个月~12岁6个月,平均6岁4个月。5例选择解剖性大脑半球切除术,9例功能性大脑半球切除术,大脑半球切除组手术时的年龄从6岁8个月~15岁1个月,平均年龄为9岁8个月,功能性大脑半球切除组年龄从1岁6个月~9岁9个月,平均年龄为5岁11个月。【结果】术后随访中无死亡病例,13例(约占92.86%)病情得到完全缓解,其中,大脑半球全切术5例全部完全缓解,功能性大脑半球切除术中1例每天仍有发作1~2次。14例术后药物均减量或者停用,目前14例患儿仍然口服抗癫痫的药物种数平均4种,其中5例减量3个月后停药。本组共6例出现手术并发症,3例为暂时性神经功能障碍,均为功能性大脑半球切除患者,3例患者的并发症均在术后2个月内缓解;3例为永久性的相应切除部位对侧肢体、手部活动功能障碍,术后1个月均能行走,均为解剖性大脑半球切除患者。两组数据进行比较,性别、术前和术后口服药物的种类、术后完全缓解的例数、癫痫确诊年龄、随访时间等没有统计学差异,手术时的年龄存在统计学差异。【结论】大脑半球切除术是治疗难治性癫痫的有效治疗手段,解剖性大脑半球切除术和功能性大脑半球切除术在治疗效果上并没有显著差异,但是功能性大脑半球切除术的术后并发症较解剖性大脑半球切除术要少。

【Objective】To investigate whether anatomical and functional cerebral hemispherectomy have differences in the treatment of children with intractable epilepsy and guide the choice of surgical methods.【Methods】The medical records of anatomical and functional hemispherectomy in our hospital from January 2013 to January 2018 were retrospectively analyzed.A total of 14 cases,including 11 males and 3 females,were diagnosed as epilepsy for the first time from 1 year and 2 months to 3 years and 4 months,with an average of 2 years and 1 month.The age of diagnosis of refractory epilepsy was from 2 years and 8 months to 12 years and 6 months,with the average age of 6 years and 4 months.5 cases underwent anatomical cerebral hemispherectomy,9 cases of functional cerebral hemispherectomy and cerebral hemispherectomy from 6 years and 8 months to 15 years and 1 month,with an average age of 9 years and8 months.The age of functional cerebral hemispherectomy from 1 year and 6 months to 9 years and 9 months,with the average age of 5 years and 11 months.【Results】There were no death cases in follow-up,13 cases(about 92.86%)had complete remission,of which all5 cases of cerebral hemispherectomy were completely remission,and1 case had 1-2 episodes every day during functional cerebral hemispherectomy.14 cases of postoperative drugs were reduced or discontinued.Currently,14 children still have 4 kinds of oral antiepileptic drugs,and 5 of them have been reduced for 3 months.In this group,there were 6 cases of surgical complications,3 cases of temporary neural dysfunction,functional cerebral hemispherical resection,3 patients with complications in 2 months after the operation,3 cases of permanent corresponding part of the limb and hand movement dysfunction,1 month after the operation can walk,all of the anatomical brain hemispherical resection.The two groups of data were compared.There was no statistical difference between the types of oral medicine,the number of complete remission after operation,the age of epileptic diagnosis,the time of follow-up,and the age of the operation.【Conclusion】Hemispherectomy is an effective treatment for intractable epilepsy.There is no significant difference in the therapeutic effect of anatomical cerebral hemispherectomy and functional cerebral hemispherectomy,but the postoperative complications of functional cerebral hemispherectomy are less than that of dissecting cerebral hemispherectomy.