应用多种手术方式治疗顽固性癫(癎)的临床研究

目的针对不同类型的顽固性癫癎病人,评估单独应用癫癎病灶切除术与联合应用多种手术方式治疗癫癎临床效果。方法手术治疗顽固性癫癎病人80例,其中53例采用几种术式结合的方法;每个病人术前均经过2年以上的正规系统的抗癫癎药物治疗,仍不能控制癫癎发作,每月发作3~4次以上;癫癎发作形式为单纯部分性发作,复杂部分性发作,强直-阵挛性发作以及伴失神发作;采用的手术方式:术中均进行皮层脑电描记(EcoG);局部致癎灶切除术27例,局部致癎灶切除术 多处软膜下横纤维切断术(MST)11例,局部致癎癎灶切除术 MST 皮层热灼术9例,局部致癎灶切除术 胼胝体前部切开术 颞前叶及海马切除术 MST33例。结果80例手术病人术后无死亡,术后2例脑水肿,1例颅内出血,1例肾功能衰竭;术后均服用一种抗癫癎药物,随访6~24个月,51例癫癎临床发作完全消失(63.8%),12例较术前显著改善(15.0%),8例有效(10.0%),6例效果差(7.5%),3例无效(3.8%);手术总有效率为88.8%,优良率为78.8%。结论应用多种手术方式治疗顽固性癫癎有满意疗效。

Clinical study of using multiple operative methods for intractable epilepsy

Objective To evaluate the surgical outcome, we used epileptic focus resection alone or combining multiple operative methods to treat the patients suffering from the various kind of intractable epilepsy. Methods 80 patients suffering from intractable epilepsy were performed surgical treatment, thereinto 53 patients were treated by using multiple operative methods. The patients ranged from 6 to 50 years old (average 20 years old) with present history from 3 to 41 years old (average 17 years old). Different seizure patterns were observed in the candidates containing simple partial seizure, complex partial seizure and tonic-clonic seizure. All 80 patients had the preoperative examination of scalp video-electroencephalography (v-EEG) monitoring and magnetic resonance imaging (MRI), while 35 of them had single photon emission computed tomography (SPECT), 3 patients had positron emission computed tomography (PET) and 5 patients had magnetoencephalography (MEG). We had the following operational methods : 27 patients had local epileptic focus resection (LEFR), while 11 had LEFR plus multiple cortical subpial transsection (MST), 9 LEFR plus MST and brain cortical fever cauterization (BCFC), 33 patients had LEFR combined with MST, anterior temporal lobectomy (ATL) plus hippocampectomy and anterior corpus callosotomy. All the patients had been performed with the guidance of intraoperative electrocordicography (ECoG). Results Among 80 operative patients, no mortality occurred, however, two patients occurred hydrocephalus, one intracranial hemorrhage and one renal failure. Follow-up from 3 to 24 months were available for these patients. After operation they both have peroral administration of anti-epileptic drug.Clinical epileptic seizure for 51 patients were disappeared completely (63.8%), for 12 patients had significant improved than pre-operative(15.0%), however, 8 patients had effect partially(10.0%) , 6 patients had no satisfactory effect(7.5%) and 3 had no effect(3.8%). Total effective rate of the operation was 88.3%, while fineness rate was 80%. Conclusions Using multiple operative methods to treat the intractable epilepsy were safe and effective.