【摘要】：目的:探討局灶性皮質發(fā)育患者手術效果及預后影響因素。方法:收集2014年1月1日至2014年12月31日期間于廣東三九腦科醫(yī)院經(jīng)手術治療的局灶性皮質發(fā)育不良(Focal cortical dysplasia,FCD)患者,隨訪6~16月,根據(jù)Engel分級將患者分為預后好組(Engel I級)和預后差組(Engel II-IV級),分析比較兩組患者的臨床表現(xiàn)、檢查結果、病理分類等臨床資料的差異。結果:共102例患者,男65例(63.7%),女37例(36.3%),起病年齡2月-45歲,平均10.3歲,手術年齡3歲-47歲,平均21.21歲,均有癲癇發(fā)作,預后好組83例(81.4%),預后差組19例(18.6%)。預后好組起病年齡小于3歲例數(shù)占14.5%,出現(xiàn)智力減退例數(shù)比例為45.2%,術前腦電圖非局灶性癇樣放電率59.8%,磁共振(MRI)陰性率36.1%,磁共振定位與腦電圖定位不一致率32.5%,術后腦電圖癇樣放電率49.4%。預后差組分別為36.8%、72.2%、89.5%、68.4%、94.1%、89.5%。預后好組操作智商(Performance intelligence quotient,PIQ)平均分為89.4分,預后差組為65.80分。兩組間比較差異均有統(tǒng)計學意義(P0.05)。結論:局灶性皮質發(fā)育不良患者手術預后總體較好,起病年齡小于3歲、術前出現(xiàn)智力減退、操作智商得分低、術前腦電圖非局灶性癇樣放電、MRI陰性、磁共振與腦電圖定位不一致、術后腦電圖癇樣放電可能為手術預后不良的危險因素。
[Abstract]:Objective: to investigate the operative effect and prognostic factors in patients with focal cortical development. Methods: patients with focal cortical dysplasia (Focal cortical dysplasia FCD) were collected from January 1, 2014 to December 31, 2014 in Sanjiu brain Hospital of Guangdong, and were followed up for 6 ~ 16 months. According to the Engel grade, the patients were divided into good prognosis group (Engel I grade) and poor prognosis group (Engel II-IV grade). The differences of clinical manifestations, examination results and pathological classification between the two groups were analyzed and compared. Results: there were 102 patients, 65 males (63.7%) and 37 females (36.3%). The onset age was from 2 months to 45 years old (mean 10.3 years), the operative age was 3 to 47 years old (mean 21.21 years). All patients had seizures. 83 cases (81.4%) had good prognosis and 19 cases (18.6%) had poor prognosis. In the group with good prognosis, the onset age was less than 3 years old, the incidence of mental retardation was 45.2%, the rate of non-focal epileptiform discharge was 59.8%, the negative rate of magnetic resonance (MRI) was 36.1%, the rate of mismatch between magnetic resonance localization and EEG location was 32.5%. The epileptiform discharge rate was 49.4%. The prognosis of the poor group was 36.8% and 72.2% and 89.5%, 68.4% and 94.1% respectively. The average score of (Performance intelligence quotient IQ was 89.4 in the good prognosis group and 65.80 in the poor prognosis group. The differences between the two groups were statistically significant (P0.05). Conclusion: the prognosis of the patients with focal cortical dysplasia is good, the onset age is less than 3 years old, the preoperative intelligence is decreased, the score of operational intelligence is low, and the preoperative EEG is negative for non-focal epileptiform discharges. MRI and EEG were different in localization. EEG epileptiform discharges may be the risk factors of poor prognosis after operation.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R651.1

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