儿童药物难治性癫痫手术效果及其相关影响因素研究

目的 分析儿童药物难治性癫痫手术效果,探讨影响儿童癫痫手术预后的因素.方法 选取2007年3月-2009年9月行手术治疗并随访＞1年、年龄≤14岁的药物难治性癫痫患儿76例为研究对象.根据术前进行的视频脑电图(video-EEG)、磁共振成像(MRI)、正电子发射计算机断层显像和计算机断层扫描(PET-CT)、侵入性脑电图(invasive electroencephalogram,IEEG)、神经生理学评估结果,进行以切除致痫灶为目的 的个性化的显微手术.以Engel分级法将患儿分为Ⅰ级组和Ⅱ～Ⅳ级组.对可能影响手术预后的因素进行单因素分析,再将单因素分析有统计学意义的变量进一步运用多元Logistic回归分析.结果 按Engel分级法分类:I级38例(50.0%),Ⅱ～Ⅲ级27例(35.5%),IV级11例(14.5%).无长期偏瘫或死亡病例.多元Logistic回归分析发现首发年龄＞4岁[P=0.047,OR=3.473,95% CI (1.017,11.855)]、复杂部分性发作类型[P=0.021,OR=4.678,95% CI (1.264,17.314)]、单侧颞叶切除[P=0.026,OR=3.766,95% CI(1.170,12.123)]预示Engel分级I类结果;病程、发作频率、智商(IQ)等因素对手术预后没有独立的预测作用.手术年龄、性别、MRI阳性、行PET-CT检查、行IEEG检查对手术效果没有影响.结论 手术治疗儿童药物难治性癫痫是有效、安全的.术前应进行全面的评估,并建立儿童癫痫手术纳入标准,以获得良好的预后.

Surgical Outcomes and Prognostic Factors of Children with Drug-Resistant Epilepsy

Objective To analyze the surgical outcomes of children of drug-resistant epilepsy and to investigate prognostic factors for surgery.Methods Seventy-six drug-resistant epilepsy patients(aged 14 or below) underwent operation from March 2007 to September 2009 and followed-up for at least 1 year were enrolled.Individualized microsurgical resections aimed at removal of the epileptogenic zone was performed according to the results of presurgical evaluations including video-EEG,MRI,PET-CT,invasive electroencephalo...