【摘要】 目的探讨难治性颞叶癫痫的术前评估、标准前颞叶切除术的实际应用及其疗效的影响因素。方法在显微镜下对27例难治性颞叶癫痫患者进行标准前颞叶切除术治疗。部分患者同时行皮质热灼术。术后均随访1年以上,根据手术预后按Engel’s分级情况将患者分为满意组(患者分级为Ⅰ级)与非满意组(患者分级为Ⅱ级以上),并对两组患者术前发作形式、影像学改变和脑电图监测等情况进行回顾分析。结果本组27例患者均无严重并发症发生。术后疗效Engel’s分级Ⅰ级20例(74.1%),Ⅱ级2例(7.4%),Ⅲ级4例(14.8%),Ⅳ级1例(3.7%),其中满意组患者20例,非满意组患者7例。两组间比较,满意组术前无继发性强直阵挛发作、影像学无双重改变和发作间期刺激区(IZ)局限于单侧颞区的患者比例高(均P<0.05)。结论手术前充分认识发作形式、影像学检查结果和脑电图特点,有助于提高标准前颞叶切除术的疗效。更多还原

【Abstract】 Objective To investigate the presurgical evaluation of the temporal lobe epilepsy(TLE),the practical application of standard temporalobectomy and to discuss factors that effected therapeutic efficacy.Methods Twenty-seven cases of TLE who underwent standard temporalobectomy in author’s hospital were collected.All patients were divided into satisfactory or unsatisfactory group according to outcomes after operation.The pattern of the pre-operative seizure,imaging characteristics and features of electroencephalogram were retrospectively studied and analyzed statistically.Results Twenty-seven cases did not have serious complications.According to Engel’s classification,20 cases(74.1%) achieved outcome of class Ⅰ,2 cases(7.4%) achieved outcome of class Ⅱ,4 cases(14.8%) had outcome of class Ⅲ,1 case(3.7%) had outcome of class Ⅳ.Class Ⅰ was satisfactory;class Ⅱ,Ⅲ and Ⅳ were unsatisfactory.The occurrence rates of tonic-clonic seizure,double imaging changes and nonfocal irritative zone,were higher in the unsatisfactory group than those in the satisfactory group(P<0.05).Conclusions The strict preoperative evaluation,careful presurgical studies of patterns of the preoperative seizure,imaging characteristics and features of video electroencephalogram were very helpful and prerequisite for improving the surgical outcome.更多还原