【摘要】：目的探討顳葉內(nèi)側(cè)癲癇(mesial temporal lobe epilepsy,mTLE)患側(cè)杏仁核體積與臨床特點(diǎn)、病理類(lèi)型的關(guān)系,并進(jìn)一步探討手術(shù)預(yù)后不佳的危險(xiǎn)因素。方法收集浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院癲癇中心自2013年3月至2016年3月通過(guò)臨床癥狀學(xué)和視頻腦電圖診斷為的mTLE患者35例。所有患者接受術(shù)前評(píng)估,行癲癇專(zhuān)用序列頭顱MRI及視頻腦電圖檢查。利用3D磁共振(MRI)感興趣區(qū)域(region of interest,ROI)分析,測(cè)量術(shù)前MRI雙側(cè)杏仁核體積,并計(jì)算患側(cè)杏仁核體積指數(shù)(amygdala volume index,AVI)。35例患者均接受手術(shù)治療,術(shù)后經(jīng)病理明確病因。手術(shù)后根據(jù)患者Engel分級(jí)結(jié)果將手術(shù)預(yù)后分為療效理想組(Engel Ⅰ級(jí))和療效不佳組(Engel Ⅱ級(jí)～Ⅳ級(jí))。通過(guò)對(duì)杏仁核體積的定量研究,將患側(cè)AVI與臨床特點(diǎn)、病理類(lèi)型行相關(guān)性分析,并將各因素與手術(shù)預(yù)后行單因素分析及多因素Logistic回歸分析。結(jié)果35例患者中,AVI與起病年齡(Pearson相關(guān)分析r=-0.389;P = 0.019)及手術(shù)年齡(Pearson相關(guān)分析r=-0.357;P = 0.032)均呈負(fù)相關(guān),而與性別、熱性驚厥史、病程、是否繼發(fā)全面性發(fā)作、致癇灶定側(cè)、術(shù)前發(fā)作頻率無(wú)顯著相關(guān)。所有病理結(jié)果中,13例(37.1%)為局灶性皮質(zhì)發(fā)育不良(focal cortical dysplasia,FCD),9 例(25.7%)為海馬硬化(hippocampal sclerosis,HS),7 例(20.0%)為腫瘤,4例(11.4%)為海綿狀血管瘤,2例(5.7%)為非特異性的膠質(zhì)增生改變,不同病理類(lèi)型的患側(cè)AVI無(wú)顯著差異。術(shù)后療效理想的患者有30例(85.7%),病程長(zhǎng)是mTLE患者術(shù)后療效不佳的獨(dú)立危險(xiǎn)因素(P0.05)。結(jié)論對(duì)于mTLE患者,患側(cè)杏仁核大小在術(shù)前的定側(cè)定位、病因判斷及預(yù)后評(píng)估中無(wú)較大價(jià)值。mTLE患者一旦手術(shù)指征明確,宜早期手術(shù)治療。
[Abstract]:Objective to investigate the relationship between amygdala volume and clinical features and pathological types in patients with medial temporal lobe epilepsy (mesial temporal lobe epilepsy,mTLE), and to further explore the risk factors of poor prognosis. Methods from March 2013 to March 2016, 35 mTLE patients diagnosed by clinical symptoms and video electroencephalogram were collected from the Epilepsy Center of the second affiliated Hospital of Zhejiang University Medical College. All patients were evaluated before operation, and brain MRI and video electroencephalogram (EEG) were performed. The volume of bilateral amygdaloid nucleus of MRI was measured and the volume index of amygdaloid nucleus (amygdala volume index,AVI) was calculated by 3D magnetic resonance imaging (3D-(MRI) (region of interest,ROI analysis. All 35 patients were treated by surgery, and the volume index of amygdaloid nucleus was calculated. The pathogeny was confirmed by pathology. According to the results of Engel classification, the patients were divided into two groups: the ideal group (Engel grade 鈪，

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