迷走神经电刺激术中充分剥离迷走神经鞘膜对术后癫痫发作影响的研究

Effct of fully vagal sheath peeling during vagus nerve stimulation on postoperative epileptic seizures

目的分析迷走神经电刺激术(VNS)中显微镜下充分剥离迷走神经鞘膜治疗癫痫患者的临床效果。方法选取空军军医大学西京医院神经外科自2017年10月至2021年5月收治的160例行迷走神经电极植入术的患者为研究对象,其中80例仅肉眼下常规剥离迷走神经鞘膜或不剥离鞘膜(A手术组),余80例在显微镜下充分剥离迷走神经鞘膜(B手术组)。观察开机后1、3、6、12个月,在最适刺激参数条件下,2组患者癫痫发作改善情况、语言认知功能及情绪改善情况。结果VNS术后开机1、3、6、12个月,B手术组的Ⅰ级改善率明显高于A手术组,总体有效率也均高于A手术组,差异均有统计学意义(P<0.05)。VNS术后开机12个月,B手术组的语言认知改善率、情绪改善率高于A手术组,差异均有统计学意义(P<0.05)。结论显微镜下充分剥离迷走神经鞘膜的精准手术方式可明显改善癫痫患者术后的发作和语言认知及情绪变化。

Objective To analyze the clinical effect of fully stripping vagal sheath under microscope in the treatment of epilepsy patients by vagus nerve stimulation(VNS).Methods From October 2017 to May 2021,160 patients with VNS who were admitted to Neurosurgery Department of Xijing Hospital of Air Force Military Medical University were selected.Among them,80 patients were only routinely stripped of the vagus nerve sheath or not stripped of the sheath with the naked eye(operation group A),and 80 patients were fully stripped of the vagus nerve sheath under the microscope(operation group B).At 1,3,6,and 12 months of start-up after startup,the improvement of seizure,language cognitive function,and emotion in the two groups were observed under the optimal stimulus parameters.Results At 1,3,6,and 12 months after VNS surgery,the grade I improvement rate in the operation group B was significantly higher than that in the operation group A,and the overall effective rate was also higher than that in the operation group A,with statistical significance(P<0.05).After 12 months of VNS surgery,the language cognitive improvement rate and emotional improvement rate in the operation group B were higher than those in the operation group A,with statistical significance(P<0.05).Conclusion The precise surgical method of fully stripping the vagal sheath under microscope can significantly improve the seizure,language cognition and emotional changes of epilepsy patients after operation.