CAJ | 학술논문

目的：研究MRI阳性的学龄期儿童Lennox-Gastaut 综合征（ LGS）患者切除性手术的疗效，并分析手术适应证。方法回顾性分析解放军总医院第一附属医院神经外科收治的学龄期LGS儿童患者14例，其中左侧大脑半球切除术1例，单脑叶切除术9例，多脑叶切除术4例。对患者的人口学特征和临床特征，手术方法，手术结果进行分析。结果本组患者MRI显示局限性异常6例，广泛性异常8例。病理灶全切除9例。术后1年和3年的癫痫无发作率为64．3％和57．1％。其中病理灶全切除和MRI显示局限病理者术后3年无发作率分别为75％和83．3％。术后较术前QOL改善者11例，术后IQ改善者9例。术后3年总体患者满意度评分为86．07％±12．66％。满意度与术后无癫痫发作有明显相关性（ P＝0．001）。术后使用AEDs较术前显著下降。结论切除性手术治疗学龄期儿童合并病理灶相关的LGS癫痫控制效果良好，QOL和IQ显著改善，安全性高。 MRI显示局限性病理灶的患者应当优先考虑切除性手术，完整切除病理灶疗效可能更好。
목적：연구MRI양성적학령기인동Lennox-Gastaut 종합정（ LGS）환자절제성수술적료효，병분석수술괄응증。방법회고성분석해방군총의원제일부속의원신경외과수치적학령기LGS인동환자14례，기중좌측대뇌반구절제술1례，단뇌협절제술9례，다뇌협절제술4례。대환자적인구학특정화림상특정，수술방법，수술결과진행분석。결과본조환자MRI현시국한성이상6례，엄범성이상8례。병리조전절제9례。술후1년화3년적전간무발작솔위64．3％화57．1％。기중병리조전절제화MRI현시국한병리자술후3년무발작솔분별위75％화83．3％。술후교술전QOL개선자11례，술후IQ개선자9례。술후3년총체환자만의도평분위86．07％±12．66％。만의도여술후무전간발작유명현상관성（ P＝0．001）。술후사용AEDs교술전현저하강。결론절제성수술치료학령기인동합병병리조상관적LGS전간공제효과량호，QOL화IQ현저개선，안전성고。 MRI현시국한성병리조적환자응당우선고필절제성수술，완정절제병리조료효가능경호。
Objective To study surgical outcome of resective surgery in school-aged children with MRI-positive Lennox-Gastaut syndrome ( LGS) and discuss candidate for resective operation in those patients .Methods The clinical data of 14 school-aged children with MRI-positive LGS by resective operation in our hospital , were analyzed retrospectively .One patients received anatomy , 9 hemispherectomy lobectomies and 4 multi-lobectomies .Patients'demographic and clinical characte-ristics, surgical approach and surgical outcomes were analyzed .Results Six focal abnormities and 8 diffusive finding were revealed in MRI scanning .Total resection of abnormities found in MRI were reached in 9 cases.The percentages of seizure-free were 64.3%in 1 year follow-up and 57.1%in 3 years follow-up after surgery .The percentages of seizure-free reached 83.3% in patients with focal abnormalities and 75% in patients with total resection of abnormalities in 3 years follow-up after surgery.There were 11 (78.6%) children with postoperative QOL improvements and 9 (64.3%) patients with post-operative IQ improvement in 2 years follow-up.Percentage of surgical satisfaction reached 86.89%±11.81%, and number of AEDs were significantly less than the number during pre-operative period .Significant differences were found in postoperative improvements of QOL and IQ , percentage of surgical satisfaction and number of AEDs between the children with seizure free and those with continuous seizure after operation .Conclusions Resective surgery presented good seizure control and improvement in QOL and IQ , and reduction of AEDs in school-aged children with MRI-positive LGS, furthermore, resective surgery should been taken into consider in patients with focal abnormalities in early stage , and total resection of abnormalities may present better surgical outcome .