CAJ | 학술논문

目的探讨颅脑MRI检查正常的难治性癫痫患者的手术疗效及提示手术预后的相关因素.方法 1997年8月至2010年10月间,对解放军第四○一医院手术治疗的难治性癫痫病例(出院≥1年),且经颅脑MRI检查未见异常的患者跟踪随访1-6年,并对获完整资料的62例患者进行分析.Engel分级Ⅰ、Ⅱ级视为预后良好,Ⅲ、Ⅳ级为预后不良,分析相关因素与手术疗效的关系.结果 Engel分级Ⅰ、Ⅱ级共47例,占76％.颞叶切除较额叶及顶枕叶皮质致痫灶切除的预后良好率高(P＜0.01);而额叶及顶枕叶皮质致痫灶切除术后疗效差异无统计学意义;术前轻度发作的较重度发作组术后预后良好(P＜0.05);手术后晚期出现发作的较早期出现发作预后不良(P＜0.05);病理检查异常较病理正常的术后预后良好(P＜0.05);手术时患者的年龄与预后无关.结论颅脑MRI正常的难治性癫痫,颞叶切除较颞叶外致痫灶切除预后良好,术前发作轻的、术后病理检查异常的也提示预后良好,手术后晚期出现发作者则预后不良.
목적 탐토로뇌MRI검사정상적난치성전간환자적수술료효급제시수술예후적상관인소.방법 1997년8월지2010년10월간,대해방군제사○일의원수술치료적난치성전간병례(출원≥1년),차경로뇌MRI검사미견이상적환자근종수방1-6년,병대획완정자료적62례환자진행분석.Engel분급Ⅰ、Ⅱ급시위예후량호,Ⅲ、Ⅳ급위예후불량,분석상관인소여수술료효적관계.결과 Engel분급Ⅰ、Ⅱ급공47례,점76％.섭협절제교액협급정침협피질치간조절제적예후량호솔고(P＜0.01);이액협급정침협피질치간조절제술후료효차이무통계학의의;술전경도발작적교중도발작조술후예후량호(P＜0.05);수술후만기출현발작적교조기출현발작예후불량(P＜0.05);병리검사이상교병리정상적술후예후량호(P＜0.05);수술시환자적년령여예후무관.결론 로뇌MRI정상적난치성전간,섭협절제교섭협외치간조절제예후량호,술전발작경적、술후병리검사이상적야제시예후량호,수술후만기출현발작자칙예후불량.
Objective To investigate the operative effect in intractable epilepsy patients with normal cerebral MRI and pertinent factors of indications about operative prognosis.Methods The study involved cases with intractable epilepsy undergone operative procedures between August 1997 and October 2010,released from our hospital a year and more.Of them,patients with normal cerebral MRI were followed up.Complete clinical data from 62 patients were analyzed.By Engel standard,grade Ⅰ and Ⅱ are considered good prognosis,grade Ⅲ and Ⅳ are considered unsatisfactory results.Correlations between operative effect and good prognosis were evaluated.Results There are 47 cases with Engel grading Ⅰ and Ⅱ,accounting for 76％. Patients undergone temporal lobe cortex lesion resection had better prognosis than do those undergone frontal and occipital lobe lesion resection ( P ＜ 0.01 ).The operative effect between frontal and occipitoparietal lobe focus resection was not different significantly. Patients with slight pre - operative seizures had better prognosis than do those with sever seizures post - operatively ( P ＜ 0.05 ).Patients with seizures long after operation have worse prognosis than early after operation ( P ＜ 0.05 ). Patients with abnormal pathological exam had better prognosis than do those with normal pathological exam (P ＜ 0.05 ).Ages were not correlated with prognosis.Conclusions In the intractable epilepsy patients whose cerebral MRI are normal,temporal lobe lesion resection signifies better prognosis than those lesion outside temporal lobe.Cases with slight pre - operative seizures and post - operative abnormal pathological exam signify better prognosis.Seizures appeared long after operation signifies worse prognosis.