药物难治性癫癇两种手术方式疗效比较

Comparison of Two Kinds of Operations for Drug-refractory Epilepsy

目的比较立体定向胼胝体及多靶点联合损毁术(stereotactic multiple target lesion technique,STLT)与主癫痫灶切除加软膜下横灼加胼胝体切开术(epilepsy focal resection combined with multiple subpial transection and corpus callosotomy,ERTC)治疗药物难治性癫癇(drug-refractory epilepsy,RE)的有效性及安全性。方法将作者科室近年来129例致癇灶广泛的RE患者分为两组,其中77例选择STLT治疗,52例选择ERTC治疗,随访6~18个月,分析疗效。结果术后两组术式疗效比较差异无统计学意义(Z=-1.935,P<0.05),行STLT的RE患者控制满意率组(53.2%)明显高于ERTC组(28.8%),术后两组均未发生永久性并发症。结论两种手术方式均是RE的安全有效的治疗方法,STLT手术时间短、微创、定位准确、出血少,ERTC更适合未成年人,成人有短暂并发症风险,但大多能恢复。

Objective To compare the efficacy and safety of stereotactic multiple target lesion technique(STLT)versus the epilepsy focal resection combined with multiple subpial transection and corpus callosotomy(ERTC)in treatment of drug-refractory epilepsy(RE).Methods One hundred and twenty-nine patients were divided into two groups.77 patients were treated by STLT and 52 by ERMC.The efficacy analysis was made after 6-18 months follow-up.ResultsThere were no significant differences between the two groups.The control satisfaction rate was 53.2% in STLT,while28.8%in ERMC.No permanent complication was found.Conclusions Both operations were safe and effective in the treatment of RE.STLT has shorter surgical duration,minimally invasive,accurate positioning and less intraopetative bleeding,ERMC is more suitable for minors,jureniles adult have short risk of complications,but most of them can resume.