定稿手术治疗外伤性癫痫疗效分析.docVIP

手术治疗外伤性癫痫的疗效分析 李宁 雍文盛 李明 邬正贵 罗晓琦 倪艳 刘梅 （成都核工业四一六医院神经外科） 【摘要】目的 探讨外伤性癫痫的手术方法及疗效等。方法 回顾分析手术治疗28例外伤性癫痫患者。采取致痫灶切除术5例，致痫灶切除+皮质热灼术17例，前颞叶、杏仁核一海马切除+皮质热灼术4例，致痫灶切除+皮质热灼术+胼胝体前部切开术2例。结果 随访1～6年。术后结果评价达到满意或显著改善者归于满意组，共21例（75.0％），术后评价良好、较差者归于不满意组，共7例（25.0％）。本组28例中，5例痫灶局限仅需一种手术方式（致痫灶切除），效果均属于满意组(5/5)；另外23例手术中至少使用了两种手术方式，属满意组16例（16/23），可以明确痫灶局限仅需一种手术方式者效果最好。不满意组的7例病人中，仅1例无继发全身性发作(1/7)，而满意组21例中无继发全身性发作占9例(9/21)。结论 癫痫灶广泛、发作来源多灶、癫痫灶位于运动区者手术效果较差，需要多种术式联合应用；无继发全身性发作者手术效果好。 【关键词】外伤性癫痫；癫痫灶；手术治疗 Efficacy Analysis of Surgical Treatment for Post-Traumatic Epilepsy Li ning，yong wen sheng，et al. Department of Neurosurgery， The 416 Hospital of Nuclear Industry，Chengdu 610051，China 【Abstract】Objective To surgical methods of post—traumatic epilepsy(PTE) and evaluate effects of the therapy. Methods Clinical data of 28 patients with PTE in our hospital were analyzed retrospectively. 5 patients received the resection of the epileptogenic foci，17 received the resection of the epileptogenic foci and bipolar coagulation of functional cortexes，4 received anterior temporal lobectomy and amygdalo-hippocampectomy and bipolar coagulation of functional cortexes， and 2 received the resection of the epileptogenic foci and bipolar coagulation of functional cortexes and anterior callosotomy. Results All the patients were followed up from 1 to 6 years after the treatment．Patients got satisfactory effect or significant improvement were accounted as satisfied group，at a total of 21 cases (75.0％). Patients got less effect were accounted as dissatisfied group and 7cases in all(25.0％). 5 cases with limited epileptic foci，only need one surgery way (resection of epileptogenic foci)，all the treatment effect belongs to the satisfied group (5/5). 23 patients were treat with two surgery ways or more，and 16 of them(16/23) were accounted into the satisfied group. Its show that patients with limited Epileptic foci could get well effect by a single operation method. In dissatisfied group ( 7 cases)， only 1 case (1 /