幕上胶质瘤切除后皮层脑电癫痫样放电增多的危险因素分析

目的探讨皮层脑电(electrocorticography,ECoG)监护下幕上胶质瘤切除后癫痫样放电增多的相关因素,寻找导致幕上胶质瘤术后早期癫痫发作的危险因素。方法回顾性分析我科2006年9月至2011年11月皮层脑电监护下行幕上胶质瘤切除195例患者的临床资料,根据年龄、性别、术前癫痫史的有无、术前是否预防应用抗癫痫药术、肿瘤是否累及皮层、术前是否伴瘤周水肿、肿瘤切除程度等因素进行分组,通过对组间进行χ2检验、并计算C值(Pearson列联系数)及OR值,探讨上述因素与肿瘤切除后ECoG癫痫样放电增多的关系。结果 195例患者中肿瘤组织切除后癫痫样放电增多者53例,占27.2%。术前癫痫史、术前应用抗癫痫药物、肿瘤累及皮层、术前瘤周水肿、肿瘤非全切等因素组间经方差分析差异有统计学意义(P<0.05),其C值依次增强。术前癫痫史、肿瘤累及皮层、术前瘤周水肿、肿瘤非全切OR值>1,术前应用抗癫痫药OR值<1。年龄、性别等因素经方差分析无统计学差异(P>0.05)。结论术前癫痫史、术前应用抗癫痫药、肿瘤累及皮层、术前瘤周水肿、肿瘤非全切与幕上胶质瘤切除后癫痫样放电增多的关联性依次增强;术前癫痫史、肿瘤累及皮层、术前瘤周水肿、肿瘤非全切为危险因素,术前应用抗癫痫药为保护因素。年龄、性别与肿瘤切除后癫痫样放电增多的发生率则无明显相关。

Risk factors of epileptiform discharge increase after supratentorial glioma resection

Objective To study the related factors of epileptiform discharge increase after supratentorial glioma resection under the supervision of electrocorticography(ECoG),and to explore the risk factors of acute postoperative seizures.Methods The clinical data of 195 patients who received supratentorial glioma resection under the supervision of ECoG in our department from September 2006 to November 2011 was analyzed retrospectively.The patients were divided into different groups based on the age,sex,preoperative epilepsy history,preoperative preventive drugs application,tumor involving cortex,preoperative peritumoral brain edema and the extent of tumor resection.The relationship between these factors and the increase of postoperative epileptiform discharges was analyzed through Chi-square test,Pearson’s product-moment correlation coefficient and odds ratio.Results There were 53 patients whose postoperative epileptiform discharges increased in the 195 patients,accounting for 27.2%.The preoperative epilepsy history,preoperative preventive drug application,tumor involving cortex,preoperative peritumoral brain edema and non-total resection of tumor were significantly different between these groups(P<0.05).The C value of these factors increased in turn(P<0.05).The relative risk coefficients of preoperative epilepsy history,tumor involving cortex,preoperative peritumoral brain edema and non-total resection of tumor were greater than 1,and the relative risk coefficient of preoperative preventive drug application was less than 1.The factors such as age and sex showed no significant difference(P>0.05).Conclusion Preoperative epilepsy history,preoperative preventive drug application,tumor involving cortex,preoperative peritumoral brain edema and non-total resection of tumor are related to the increase of postoperative epileptiform discharges,showing an increasingly close relationship.Preoperative epilepsy history,tumor involving cortex,preoperative peritumoral brain edema and non-total resection of tumor are risk factors,while preoperative preventive drug application is a protective factor.The factors such as age and sex are not significantly related to the incidence of increased postoperative epileptiform discharges.