CAJ | 학술논문

目的探讨术中癫痫诱发试验对癫痫灶切除的方法和疗效.方法对118例难治性癫痫患者,在术中首先唤醒患者,利用皮层和深部电极,监测患者的棘波、尖波或棘慢、尖慢复合波等,数码标签标出致痫灶的范围,加深麻醉后手术切除和(或)皮层热灼,再次促醒患者并给予过度换气,使二氧化碳分压( PCO2)在20 ～ 25 mmHg,持续5 min,复测脑电波,测得棘波、尖波标记后,再次加深麻醉给予切除和(或)皮层热灼.结果 (1)118例患者中,除3例儿童患者因术中不合作,在较浅的麻醉下完成手术外,115例患者经过麻醉的清醒、过度换气诱发试验后,均顺利完成了手术.术中无一例出现癫痫发作.(2)根据唤醒条件下测得结果,手术后虽然癫痫波基本消失,但经过度换气诱发试验,发现仍有63例再次测出癫痫波,经再次手术后,过度换气诱发,复测癫痫波消失.(3)术后随访:本组无手术死亡,2例不全性运动性失语,术后半年恢复,2例不完全偏瘫术后1年基本恢复,3例胶质细胞瘤患者死亡,5例失访,110例患者得到了随访,时间3 - 33个月,平均18.5个月.根据Engel术后效果分级进行评估:Ⅰ级74例,Ⅱ级27例,Ⅲ级6例,Ⅳ级3例.结论术中癫痫诱发试验,在癫痫灶切除术中具有非常重要的指导意义,值得进一步探讨.
목적 탐토술중전간유발시험대전간조절제적방법화료효.방법 대118례난치성전간환자,재술중수선환성환자,이용피층화심부전겁,감측환자적극파、첨파혹극만、첨만복합파등,수마표첨표출치간조적범위,가심마취후수술절제화(혹)피층열작,재차촉성환자병급여과도환기,사이양화탄분압( PCO2)재20 ～ 25 mmHg,지속5 min,복측뇌전파,측득극파、첨파표기후,재차가심마취급여절제화(혹)피층열작.결과 (1)118례환자중,제3례인동환자인술중불합작,재교천적마취하완성수술외,115례환자경과마취적청성、과도환기유발시험후,균순리완성료수술.술중무일례출현전간발작.(2)근거환성조건하측득결과,수술후수연전간파기본소실,단경과도환기유발시험,발현잉유63례재차측출전간파,경재차수술후,과도환기유발,복측전간파소실.(3)술후수방:본조무수술사망,2례불전성운동성실어,술후반년회복,2례불완전편탄술후1년기본회복,3례효질세포류환자사망,5례실방,110례환자득도료수방,시간3 - 33개월,평균18.5개월.근거Engel술후효과분급진행평고:Ⅰ급74례,Ⅱ급27례,Ⅲ급6례,Ⅳ급3례.결론 술중전간유발시험,재전간조절제술중구유비상중요적지도의의,치득진일보탐토.
Objective To study intraoperative epilepsy inducing test and its effect in the epileptogenic focus resection.Method The study included 118 patients with refractory epilepsy.During surgery,the patients were first woken up.With cortical and depth electrodes,the patient's spike wave,sharp wave or spike slow,sharp slow complex wave,etc.were monitored.The range of epileptogenic foci was marked with digital label.Under deep anesthesia,the foci was resected and the cortex was heat burned.The patients were woken up again,and hyperventilated,the carbon dioxide partial pressure (PCO2) kept at 20 ～ 25 mmHg for 5 minutes.The brain waves were measured again.After marking the spike and sharp waves,the anesthesia was deepened again,and resection and cortex heat burning were applied.Results (1) Of the 118 patients,except 3 children performed under light anesthesia because of noncooperation,115 patients all successfully underwent the surgery,going through consciousness recovery,hyperventilation inducing test after general anesthesia,without intraoperative seizures.(2)According to the results by arousal conditions,despite postoperative epileptic wave basically disappeared,the epileptic waves were still detected in 63 patients after hyperventilation inducing test.The epileptic wave disappeared after repeated operation and hyperventilation inducing test.(3) Postoperative follow - up showed no operative death,incomplete motor aphasia in 2 cases and recovered in 6 months.2 cases with incomplete paralysis recovered after 1 year.3 patients with glioblastoma died.5 patients were not traceable.110 patients were followed up for 3 -33 months (mean 18.5 months).According to Engel's postoperative evaluation,74 cases were grade Ⅰ,27 cases were grade Ⅱ,6 cases were grade Ⅲ,3 cases were grade Ⅳ.Conclusions Intraoperative epilepsy inducing test has very important significance in the epileptic focus resection and deserves to further exploration.