伽玛刀与手术在颞叶癫痫治疗中的临床疗效比较

目的探讨并比较伽玛刀与手术在颞叶癫痫治疗中的临床疗效。方法某院于2000年1月～2009年1月对收治的颞叶癫痫患者分别采用伽玛刀与手术治疗,并比较两种治疗方法的临床疗效及并发症发生情况。结果两组患者经过积极治疗后,伽马刀组患者中满意36例,显著改善6例,良好7例,总有效率达87.50%;而手术组患者中满意40例,显著改善5例,良好2例,总有效率达94.00%;经统计学分析发现两组患者的满意率、显著改善率、良好率及总有效率差异均无统计学意义(χ2=3.21、0.01、2.46、1.31、1.31,P均﹥0.05)。伽马刀组患者中有2例患者在术后6～12个月出现精神症状,但是经过常规激素、甘露醇治疗后症状均消失,无病残和死亡病例;手术组患者在术后出现暂时性偏瘫2例,轻度同向视野缺损4例,硬膜外血肿1例(钻空外引流后完全恢复),记忆力减退2例。对两组的术后并发症进行统计学分析显示伽马刀组患者术后并发症发生率明显低于手术组,且差异有统计学意义(χ2=5.91,P=0.02)。而且伽马刀组患者中未发生致残病例,而手术组中出现2例暂时性偏瘫。结论手术治疗颞叶瘢痛的临床疗效稍微好于伽玛刀,但手术治疗具有死亡和致残的风险,而伽玛刀治疗颞叶癫瘸的疗效明确,且并发症少、轻微,但是治疗后部分患者有复发的可能,针对这部分患者可以在伽玛刀治疗失败后选择手术进行第2次治疗。

comparison of the clinical efficacy between Gamma knife and operation in temporal lobe epilepsy therapy

OBJECTIVE To investigate and compare the clinical efficacy of gamma knife and operation in temporal lobe epilepsy therapy.METHODS In our hospital from January 2000 to January 2009,patients with temporal lobe epilepsy were treated by gamma knife treatment and operation,and compared the clinical effects of two treatment methods and complications.RESULTS Among the two groups of patients after treatment,gal of saber were satisfactory in 36 cases,significant improvement in 6 cases,good in 7 cases,and the total effective rate was 87.50%;The operation were satisfactory in 40 cases,significant improvement in 5 cases,good in 2 cases,and the total effective rate was 94%;There was no significant difference between the two groups patient regarding satisfaction rate,significantly improved rate,good rate and total effective rate(χ2 = 3.21,0.01,2.46,1.31,1.31,P﹥0.05).In the Gal of saber group,2 cases showed the onset of psychotic symptoms after 6-12 months.However,after conventional hormone and mannitol treatment,the symptom disappeared,no disability and death patients presented;2 patients showed transient hemiplegia after operation,4 cases showed mild to the visual field defect,1 case showed epidural hematoma(air drilling drainage after complete recovery),and 2 cases showed memory decline.For the postoperative complications,the postoperative complications’ incidence in display gamma group was significantly lower than in operation group,and the difference was statistically significant(χ2 = 5.91,P = 0.02).The gamma knife patients did not show any disability,and operation group appeared in 2 cases of transient hemiplegia.CONCLUSION The clinical efficacy of operation for temporal lobe scar pain was slightly better than the gamma knife treatment,but the operation had the probability of death and cripple,and the efficacy of gamma knife radiosurgery in mesial temporal lobe epilepsy lame is clear,and few and minor complications,but patients may have recurrence after treatment.Patients can be treated with gamma knife after the failure for the second time.