本文選題：正電子發(fā)射計(jì)算機(jī)斷層掃描 + 動(dòng)態(tài)視頻腦電圖��； 參考：《福建醫(yī)科大學(xué)》2013年碩士論文

【摘要】：[目的] 運(yùn)用正電子發(fā)射計(jì)算機(jī)斷層掃描(PET-CT)、動(dòng)態(tài)視頻腦電圖(VEEG)、顱腦磁共振（MRI）三項(xiàng)檢查技術(shù)，研究它們?cè)谛弘y治性癲癇患者術(shù)前定位及術(shù)后療效中的臨床意義，探討PET-CT、VEEG和MRI三項(xiàng)檢查綜合評(píng)價(jià)小兒難治性vr癇患者病灶定位及術(shù)后預(yù)后的臨床價(jià)值，從而選擇最佳的檢查方法；觀察r-氨基丁酸(r-GABA)在難治性癲癇患兒腦組織中的表達(dá)情況,探討其在難治性癲癇發(fā)病機(jī)制中的作用。 [方法] 第一部分：對(duì)我院2011年8月至2012年3月期間神經(jīng)外科癲癇研究治療中心診斷為難治性癲癇的30例患兒的臨床影像學(xué)資料進(jìn)行收集，同時(shí)將手術(shù)切除的腦組織標(biāo)本進(jìn)行光學(xué)顯微鏡觀察，并且進(jìn)行病理學(xué)診斷。對(duì)行VEEG和MRI兩項(xiàng)檢查的，結(jié)果與其病理結(jié)果進(jìn)行比較，術(shù)后隨訪半年，觀察術(shù)后療效；對(duì)行PET-CT、VEEG、MRI三項(xiàng)檢查的，，結(jié)果與其病理結(jié)果進(jìn)行比較，術(shù)后隨訪半年，觀察術(shù)后療效。將采取兩項(xiàng)檢查的術(shù)后療效和采取三項(xiàng)檢查的術(shù)后療效進(jìn)行比較。 第二部分：15例患兒均來自我院神經(jīng)外科癲癇研究治療中心，經(jīng)臨床癥狀學(xué)及VEEG、MRI、PET/CT檢查等綜合評(píng)估的方法，確定致癇灶并行神經(jīng)功能外科學(xué)手術(shù)切除致癇灶治療,將手術(shù)切除的腦組織顳葉皮層標(biāo)本(實(shí)驗(yàn)組)和8例非癲癇病史的患兒的手術(shù)切除的正常腦組織標(biāo)本（腦腫瘤4例，腦血腫4例）(對(duì)照組)進(jìn)行比較。免疫組織化學(xué)染色方法采用pv-9000法（二步法免疫組化檢測(cè)試劑）標(biāo)記兩組腦組織標(biāo)本中的γ－氨基丁酸(γ-GABA)能神經(jīng)元,于光鏡(×200)倍視野下計(jì)數(shù),對(duì)兩組γ－GABA能神經(jīng)元個(gè)數(shù)進(jìn)行統(tǒng)計(jì),同時(shí)觀察實(shí)驗(yàn)組顳葉皮層光鏡(×100,×200)下存在的病理學(xué)改變。采用SPSS13.0統(tǒng)計(jì)軟件包對(duì)數(shù)據(jù)進(jìn)行處理,實(shí)驗(yàn)組和對(duì)照組采用兩獨(dú)立樣本的t檢驗(yàn)方法,以P 0.05為差異有統(tǒng)計(jì)學(xué)意義。 [結(jié)果] 第一部分：30例患兒中,有24例患兒行PET/CT、VEEG和MRI三項(xiàng)檢查，三者病灶定位一致14例,手術(shù)有效率為91.5%；有6例患兒行VEEG和MRI兩項(xiàng)檢查，兩者病灶定位一致4例，手術(shù)有效率為66.7%。 第二部分：實(shí)驗(yàn)組與對(duì)照組比較,實(shí)驗(yàn)組陽性細(xì)胞個(gè)數(shù)為116.04±30.58，對(duì)照組陽性細(xì)胞個(gè)數(shù)191.78±79.65，實(shí)驗(yàn)組γ－GABA能神經(jīng)元表達(dá)水平較對(duì)照組下降,顯著性差異具有統(tǒng)計(jì)學(xué)意義(P 0.05)。實(shí)驗(yàn)組顳葉皮層可見神經(jīng)元丟失、變性及膠質(zhì)細(xì)胞增生、肥大、突起增多，顳葉皮質(zhì)各層中GAD67免疫組化染色結(jié)果，可見皮質(zhì)細(xì)胞層次結(jié)構(gòu)紊亂，皮質(zhì)結(jié)構(gòu)發(fā)育不良伴不成熟神經(jīng)元，血管周圍淋巴細(xì)胞浸潤，皮層水腫伴小軟化灶形成等病理學(xué)改變。 [結(jié)論] 1.本研究顯示各種檢查技術(shù)都是從癲癇的不同角度進(jìn)行研究，各有優(yōu)劣，所以不能僅憑一種技術(shù)給予明確的定位，應(yīng)根據(jù)臨床表現(xiàn)，發(fā)作類型，神經(jīng)精神心理評(píng)估等各方面有針對(duì)地選作各項(xiàng)檢查。PET/CT、VEEG、MRI三項(xiàng)檢查技術(shù)綜合起來對(duì)術(shù)前致癇灶的準(zhǔn)確定位有較大的指導(dǎo)意義。對(duì)術(shù)前確定手術(shù)方案有較好的作用。手術(shù)治療癲癇效果滿意。 2.本研究顯示膠質(zhì)細(xì)胞形態(tài)學(xué)的改變，神經(jīng)元細(xì)胞數(shù)目、形態(tài)的變化最有可能是小兒難治性癲癇的發(fā)病機(jī)制之一。 3.同時(shí)病理學(xué)還可觀察到皮質(zhì)發(fā)育不良、皮質(zhì)結(jié)構(gòu)的紊亂、噬神經(jīng)、血管周圍神經(jīng)浸潤等多種病理學(xué)改變，這些病理學(xué)的改變都有可能是小兒難治性癲癇的發(fā)病機(jī)制之一。 4.免疫組織化學(xué)染色顯示實(shí)驗(yàn)組和對(duì)照組神經(jīng)元胞漿中均可見棕褐色陽性細(xì)胞,表明均有r-氨基丁酸能神經(jīng)元表達(dá),實(shí)驗(yàn)組數(shù)量明顯低于對(duì)照組。 5.實(shí)驗(yàn)組數(shù)量明顯低于對(duì)照組,推測(cè)其可能與難治性癲癇的發(fā)生存在一定的關(guān)系。
[Abstract]:Purpose of the project

The clinical significance of positron emission computed tomography ( PET - CT ) , dynamic video electroencephalogram ( VEEG ) and brain magnetic resonance ( MRI ) in children with refractory epilepsy was studied .
To investigate the expression of r - aminobutyric acid ( r - aminobutyric acid ) in brain tissue of children with refractory epilepsy and to investigate its role in the pathogenesis of intractable epilepsy .

Methodology

In the first part , the clinical imaging data of 30 children with refractory epilepsy were collected from August 2011 to March 2012 in our hospital , meanwhile , the brain tissue samples were examined by optical microscope and pathology diagnosis was performed . The results were compared with the pathological results of VEEG and MRI .
The results of three examinations of PET - CT , VEEG and MRI were compared with the pathological results , and the postoperative follow - up period was half a year after operation . The results of two examinations were compared with those of three examinations .

In the second part : 15 cases of children were treated by the comprehensive evaluation method of neurological surgery epilepsy in our hospital , clinical symptoms and VEEG , MRI , PET / CT examination and so on . The pathological changes of the two groups of 緯 - aminobutyric acid ( 緯 - GABA ) neurons were determined by using the method of pv - 9000 ( two - step immunohistochemical detection reagent ) .

The result is not valid .

The first part : Of the 30 cases , 24 children were examined with PET / CT , VEEG and MRI . The three lesions were consistent in 14 cases and the effective rate was 91.5 % .
There were 6 cases with VEEG and MRI examination . The lesions were consistent in 4 cases and the effective rate was 66.7 % .

The second part : Compared with the control group , the number of positive cells in the experimental group was 116 . 04 鹵 30 . 58 , the number of positive cells in the control group was 191 . 78 鹵 79.65 , the expression level of 緯 - GABA - ergic neurons in the experimental group was lower than that of the control group , and the significant difference was statistically significant ( P 0.05 ) . The expression of GAD67 was found in the cortex of temporal lobe of experimental group , degeneration and glial cell hyperplasia , hypertrophy , increased protrusion and GAD67 immunohistochemical staining in each layer of temporal lobe cortex . The pathological changes of cortical cell structure disorder , cortical dysplasia with immature neurons , peripheral lymphocyte infiltration , cortical edema and formation of small softening range were seen .

Conclusion

1 . The study shows that all kinds of examination techniques have been studied from different angles of epilepsy . Therefore , it can not only be clearly positioned by one technique , but it should be selected according to the clinical manifestation , type of attack , neuropsychological assessment and so on . PET / CT , VEEG and MRI have a great guiding significance for the accurate positioning of the pre - operative epileptogenic foci .

2 . This study shows that the changes of glial cell morphology , the number of neurons and the change of morphology are most likely to be one of the pathogenesis of intractable epilepsy in children .

3 . At the same time , we can observe the pathological changes of cortical dysplasia , cortical structure disturbance , tophagy and peripheral nerve infiltration , which may be one of the pathogenesis of intractable epilepsy in children .

4 . Immunohistochemical staining showed that brown - brown positive cells were found in the cytoplasm of neurons in the experimental group and the control group , indicating that the r - aminobutyric acid was able to express the neurons , and the number of experimental groups was significantly lower than that of the control group .

5 . The number of experimental groups was significantly lower than that of the control group , and it was speculated that it might be related to the occurrence of intractable epilepsy .
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R742.1

【共引文獻(xiàn)】

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