摘要
目的探讨脑叶离断术治疗儿童药物难治性癫痫(DRE)的手术方法、并发症及预后。方法回顾性纳入2014年6月至2017年7月北京大学第一医院儿童癫痫中心行脑叶离断手术的DRE患儿,共39例。其中,颞、顶、枕叶离断术30例,顶、枕叶离断术4例,大脑半球次全离断术4例,额、顶叶离断术1例。术后口服1~3种抗癫痫药物治疗。应用Engel分级标准评估术后疗效。结果39例患儿平均手术时间为(4.5±1.0)h,平均出血量为(214.6±100.3)ml。术后随访时间为6~36个月,中位数为14个月。随访期共8例(20.5%)有发作。Engel分级Ⅰ级者31例(79.5%),Ⅱ级者4例(10.2%),Ⅲ级者1例(2.6%),Ⅳ级者3例(7.7%)。1例(2.6%)单纯疱疹病毒性脑炎患儿术后复发;1例(2.6%)额、顶叶离断者术后出现对侧肢体运动功能障碍,随访期间运动功能有明显进步。所有患儿无术后感染、脑积水等并发症。结论脑叶离断术是儿童癫痫外科手术中常用的手术方式,尤其是针对低龄儿童。术后疗效好,具有创伤小、出血少、手术时间短及术后并发症少的优点。
Objective To explore the procedure, efficacy, complications and outcomes of multi-lobe disconnection for children with intractable epilepsy. Methods The authors conducted a retrospective review of clinical data in children with intractable epilepsy who underwent multi-lobe disconnection at Peking University Pediatric Epilepsy Center between June 2014 and July 2017. Thirty-nine patients who had experienced various kinds of lobe disconnection surgery were collected. Among them, 30 patients underwent temporo-parieto-occipital disconnection, 4 underwent parieto-occipital disconnection, 4 underwent subtotal hemispherotomy and 1 underwent frontoparieto disconnection. One to three antiepileptic drugs were taken after operation. The outcomes were evaluated based on Engel's classification. Results In 39 patients, the average surgical time was 4.5±1.0 h and the average blood loss was 214.6±100.3 ml. All patients had been followed up ranging from 6 to 36 months, and the median time was 14 months. During the follow-up, 8 (20.5%) patients had seizure recurrence. Most patients had good seizure outcomes [Engel Ⅰ: 79.5%(31 cases), Engel Ⅱ: 10.2%(4 cases), Engel Ⅲ: 2.6%(1 case), Engel Ⅳ: 7.7%(3 cases)]. Complications were rare. One patient(2.6%) had relapse of herpes simplex virus encephalitis. One patient had weakness on the contralateral side of body immediately post surgery and recovered later. No intracranial infection or hydrocephalus occurred. Conclusion Multi-lobe disconnection is common and effective for children, particularly young children, with intractable epilepsy and is characterized by less trauma, less bleeding, shorter operative time.
出处
《中华神经外科杂志》
CSCD
北大核心
2019年第3期245-249,共5页
Chinese Journal of Neurosurgery
基金
北京市自然科学基金重点项目(7151010)
北京脑科学研究专项(Z161100000216133).
关键词
癫痫
儿童
神经外科手术
治疗结果
脑叶离断术
Epilepsy
Child
Neurosurgical procedures
Treatment outcome
Multi-lobe disconnection
