中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
16期
1267-1272
,共6页
耐药性癫(痫)%癫(痫)手术%再次手术%术后疗效%预测因素
耐藥性癲(癇)%癲(癇)手術%再次手術%術後療效%預測因素
내약성전(간)%전(간)수술%재차수술%술후료효%예측인소
Drug resistant epilepsy%Epilepsy surgery%Reoperation%Postoperation outcome%Predictor
目的 分析首次切除性手术失败或复发的耐药性癫(痫)患儿再次手术治疗的术后疗效,探讨再次手术术后疗效的预测因素及癫(痫)切除术的临床价值.方法 对2011年9月至2012年9月南京军区福州总医院神经外科癫(痫)中心再次手术治疗的4例耐药性癫(痫)患儿首次手术前后的临床资料,及再次手术术前评估、术后随访等进行分析.结果 首次切除性手术后,3例发作无明显减少(Engel Ⅳ级),1例无发作(Engel Ⅰ级),但2年后复发.经再次全面评估后,4例均行扩大范围切除性手术,其中3例行颞顶枕叶致(痫)灶切除术,1例行额叶致(痫)灶切除术.术后平均随访11.25个月,均无重大的或不能接受的并发症,达到Engel Ⅰ～Ⅱ级.结论 对首次切除性手术治疗失败的患儿,经全面评估后,再切除性手术可重新获得无发作.再切除性手术术后疗效积极的预测因素:(1)残留有颞叶内侧结构或磁共振成像示结构性异常;(2)首次切除性手术未达最佳标准;(3)术前已明确有独立的致(痫)灶;(4)首次切除性手术前后发作症候学具有相关性.
目的 分析首次切除性手術失敗或複髮的耐藥性癲(癇)患兒再次手術治療的術後療效,探討再次手術術後療效的預測因素及癲(癇)切除術的臨床價值.方法 對2011年9月至2012年9月南京軍區福州總醫院神經外科癲(癇)中心再次手術治療的4例耐藥性癲(癇)患兒首次手術前後的臨床資料,及再次手術術前評估、術後隨訪等進行分析.結果 首次切除性手術後,3例髮作無明顯減少(Engel Ⅳ級),1例無髮作(Engel Ⅰ級),但2年後複髮.經再次全麵評估後,4例均行擴大範圍切除性手術,其中3例行顳頂枕葉緻(癇)竈切除術,1例行額葉緻(癇)竈切除術.術後平均隨訪11.25箇月,均無重大的或不能接受的併髮癥,達到Engel Ⅰ～Ⅱ級.結論 對首次切除性手術治療失敗的患兒,經全麵評估後,再切除性手術可重新穫得無髮作.再切除性手術術後療效積極的預測因素:(1)殘留有顳葉內側結構或磁共振成像示結構性異常;(2)首次切除性手術未達最佳標準;(3)術前已明確有獨立的緻(癇)竈;(4)首次切除性手術前後髮作癥候學具有相關性.
목적 분석수차절제성수술실패혹복발적내약성전(간)환인재차수술치료적술후료효,탐토재차수술술후료효적예측인소급전(간)절제술적림상개치.방법 대2011년9월지2012년9월남경군구복주총의원신경외과전(간)중심재차수술치료적4례내약성전(간)환인수차수술전후적림상자료,급재차수술술전평고、술후수방등진행분석.결과 수차절제성수술후,3례발작무명현감소(Engel Ⅳ급),1례무발작(Engel Ⅰ급),단2년후복발.경재차전면평고후,4례균행확대범위절제성수술,기중3례행섭정침협치(간)조절제술,1례행액협치(간)조절제술.술후평균수방11.25개월,균무중대적혹불능접수적병발증,체도Engel Ⅰ～Ⅱ급.결론 대수차절제성수술치료실패적환인,경전면평고후,재절제성수술가중신획득무발작.재절제성수술술후료효적겁적예측인소:(1)잔류유섭협내측결구혹자공진성상시결구성이상;(2)수차절제성수술미체최가표준;(3)술전이명학유독립적치(간)조;(4)수차절제성수술전후발작증후학구유상관성.
Objective To analyze the outcome of reoperation in drug resistant epilepsy after failed surgery or recurrence in children,and to identify the predictors of the outcome of reoperation and inspiration of epilepsy resection surgery.Methods Analysis was done on data of 4 patients with drug resistant epilepsy diagnosed in Department of Neurosurgery Epileptic Center,Fuzhou General Hospital of Nanjing Military Command from Sep.2011 to Sep.2012.Clinical manifestation,preoperative evaluation,postoperative follow-up of the children were analyzed.Results After first epilepsy resection surgery,3 patients had little decrease in seizure rate(Engel class Ⅳ),the other one had seizure freedom (Engel class Ⅰ),but got recurrence after 2 years.Four cases were all underwent extended resection reoperation du-ring the study period.Types resection included temporoparietooccipital (3/4 cases) and frontal (1/4 cases),mean follow-up 11.25 months.One of the 4 patients had seizure freedom (Engel class Ⅰ),and 3 cases of the 4 patients had seizure reduction (Engel class Ⅱ) at last follow-up,in addition,none of them had significant or unacceptable complication.Conclusions Patients with recurrent drug resistant epilepsy after an initial resection surgery can regain seizure freedom outcome when they underwent repeat resection surgery after comprehensive reevaluation.Predictors with likelihood of seizure freedom after reoperation are:(1) retained medial temporal structures or relevant magnetic resonance imaging structural lesion;(2) original surgery suboptimal; (3) preceding evaluation suggests solitary identified focus;(4) semiology relate to preoperative seizures.
