局灶性皮質(zhì)發(fā)育不良致藥物難治性癲癇的手術(shù)預(yù)后及相關(guān)影響因素分析
發(fā)布時間：2018-11-24 21:23
【摘要】：目的:本研究旨在探討局灶性皮質(zhì)發(fā)育不良(FCD)所導(dǎo)致的藥物難治性癲癇的手術(shù)預(yù)后與性別、FCD病理分型、MRI檢查結(jié)果、病灶位置是否位于顳葉、患者手術(shù)年齡、手術(shù)是否全切致癇灶之間的關(guān)系。為指導(dǎo)FCD所致的藥物難治性癲癇患者的手術(shù)預(yù)后提供理論依據(jù)。方法:回顧性分析2007年5月至2015年11月于首都醫(yī)科大學(xué)宣武醫(yī)院神經(jīng)外科收治的97例病理確診為局灶性皮質(zhì)發(fā)育不良的藥物難治性癲癇患者,回顧性分析其97例患者的癲癇手術(shù)預(yù)后情況,并分析患者性別、MRI檢查結(jié)果、致癇灶所在腦葉、手術(shù)年齡、是否全切致癇灶及FCD病理分型與癲癇手術(shù)預(yù)后之間的關(guān)系。結(jié)果:97例患者平均隨訪時間為59.18±28.62個月(15-119個月,中位隨訪時間為65個月)。其中男性61例(62.89%),女性36例(37.11%)。術(shù)后Engel I級的患者60例(61.86%),Engle II級11例(11.34%),Engle III級16例(16.49%),Engle IV級10例(10.31%)。將術(shù)后Engel I級的患者視為預(yù)后良好,術(shù)后Engel II-IV級的患者視為預(yù)后較差。將這些患者的MRI檢查結(jié)果分為MRI陽性(即影像學(xué)檢查提示明確病灶)和MRI陰性(即影像學(xué)檢查未能發(fā)現(xiàn)明確病灶);病灶位置分為位于顳葉和位于顳葉以外;患者手術(shù)年齡分為大于等于18歲和小于18歲;手術(shù)切除范圍分為全切致癇灶和未全切致癇灶;FCD病理分型依據(jù)2011年國際抗癲癇聯(lián)盟(International League Against Epilepsy,ILAE)最新分類方法分為FCD I型、II型和III型。將上述各因素分別與患者手術(shù)預(yù)后結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。最終得出:FCD致藥物難治性癲癇患者的手術(shù)預(yù)后與MRI檢查結(jié)果、患者手術(shù)年齡、是否全切致癇灶相關(guān),而性別、FCD病理分型及病灶是否位于顳葉與手術(shù)預(yù)后無統(tǒng)計(jì)學(xué)差異。以患者術(shù)后預(yù)后良好為陽性時間,將97例患者的預(yù)后結(jié)果進(jìn)行生存分析,可知FCD所致的藥物難治性癲癇患者術(shù)后5年癲癇預(yù)后良好率約為59%。結(jié)論:FCD致藥物難治性癲癇患者的性別、FCD病理分型及病灶是否位于顳葉與手術(shù)預(yù)后無統(tǒng)計(jì)學(xué)差異。患者手術(shù)年齡小于18歲、MRI檢查結(jié)果陽性及全切致癇灶的患者術(shù)后預(yù)后良好。
[Abstract]:Objective: to investigate the prognosis and sex of drug refractory epilepsy caused by focal cortical dysplasia (FCD), the pathological classification of FCD, the results of MRI, the location of the lesion in the temporal lobe, and the operative age of the patients. The relationship between surgical resection and epileptic foci. To provide a theoretical basis for the surgical prognosis of patients with drug-resistant epilepsy caused by FCD. Methods: from May 2007 to November 2015, 97 patients with intractable drug epilepsy diagnosed pathologically as focal cortical dysplasia were retrospectively analyzed in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University. The prognosis of epileptic surgery in 97 patients was analyzed retrospectively, and the relationship between the prognosis of epileptic surgery and sex, the results of MRI, the location of epileptogenic foci, the age of operation, whether the epileptogenic foci were completely removed, and the pathological classification of FCD were analyzed. Results: the mean follow-up time of 97 patients was 59.18 鹵28.62 months (15-119 months, median 65 months). There were 61 males (62.89%) and 36 females (37.11%). There were 60 cases (61.86%) of), Engle II grade I (11 cases of), Engle II grade) (11.34% of), Engle III grade 16 cases (16.49%) of), Engle IV grade 10 cases (10.31%). The patients with Engel grade I after operation were regarded as good prognosis, and those with Engel II-IV grade after operation were regarded as poor prognosis. The results of MRI examination in these patients were divided into MRI positive (that is, imaging showed definite lesion) and MRI negative (that is, no clear focus was found by imaging examination), the location of lesion was divided into temporal lobe and outside temporal lobe. The operative age of the patients was greater than 18 years old and less than 18 years old, the range of surgical resection was divided into total epileptic foci and incomplete epileptic foci. The pathological classification of FCD was classified into FCD I, II and III according to the latest classification of (International League Against Epilepsy,ILAE in 2011. The above factors were statistically analyzed with the outcome of operation. It is concluded that the prognosis of patients with drug-resistant epilepsy caused by FCD is related to the results of MRI examination, the age of operation, whether the epileptogenic foci are completely incised, but there is no significant difference in sex, pathological classification of FCD and whether the focus is located in temporal lobe or not. According to the positive time of good prognosis after operation, 97 patients' survival analysis showed that the good prognosis rate of patients with drug-resistant epilepsy caused by FCD was about 59g after 5 years. Conclusion: there is no significant difference in sex, FCD pathological classification and prognosis between patients with drug-resistant epilepsy induced by FCD. The operative age was less than 18 years old, and the prognosis was good in the patients with positive MRI findings and total resection of epileptogenic foci.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1
本文編號：2355112
[Abstract]:Objective: to investigate the prognosis and sex of drug refractory epilepsy caused by focal cortical dysplasia (FCD), the pathological classification of FCD, the results of MRI, the location of the lesion in the temporal lobe, and the operative age of the patients. The relationship between surgical resection and epileptic foci. To provide a theoretical basis for the surgical prognosis of patients with drug-resistant epilepsy caused by FCD. Methods: from May 2007 to November 2015, 97 patients with intractable drug epilepsy diagnosed pathologically as focal cortical dysplasia were retrospectively analyzed in the Department of Neurosurgery, Xuanwu Hospital, Capital Medical University. The prognosis of epileptic surgery in 97 patients was analyzed retrospectively, and the relationship between the prognosis of epileptic surgery and sex, the results of MRI, the location of epileptogenic foci, the age of operation, whether the epileptogenic foci were completely removed, and the pathological classification of FCD were analyzed. Results: the mean follow-up time of 97 patients was 59.18 鹵28.62 months (15-119 months, median 65 months). There were 61 males (62.89%) and 36 females (37.11%). There were 60 cases (61.86%) of), Engle II grade I (11 cases of), Engle II grade) (11.34% of), Engle III grade 16 cases (16.49%) of), Engle IV grade 10 cases (10.31%). The patients with Engel grade I after operation were regarded as good prognosis, and those with Engel II-IV grade after operation were regarded as poor prognosis. The results of MRI examination in these patients were divided into MRI positive (that is, imaging showed definite lesion) and MRI negative (that is, no clear focus was found by imaging examination), the location of lesion was divided into temporal lobe and outside temporal lobe. The operative age of the patients was greater than 18 years old and less than 18 years old, the range of surgical resection was divided into total epileptic foci and incomplete epileptic foci. The pathological classification of FCD was classified into FCD I, II and III according to the latest classification of (International League Against Epilepsy,ILAE in 2011. The above factors were statistically analyzed with the outcome of operation. It is concluded that the prognosis of patients with drug-resistant epilepsy caused by FCD is related to the results of MRI examination, the age of operation, whether the epileptogenic foci are completely incised, but there is no significant difference in sex, pathological classification of FCD and whether the focus is located in temporal lobe or not. According to the positive time of good prognosis after operation, 97 patients' survival analysis showed that the good prognosis rate of patients with drug-resistant epilepsy caused by FCD was about 59g after 5 years. Conclusion: there is no significant difference in sex, FCD pathological classification and prognosis between patients with drug-resistant epilepsy induced by FCD. The operative age was less than 18 years old, and the prognosis was good in the patients with positive MRI findings and total resection of epileptogenic foci.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.1
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 孫恒;姜磊;買買提江;石鑫;馮兆海;郝玉軍;;局灶性腦皮質(zhì)發(fā)育不良致頑固性癲癇的手術(shù)預(yù)后及其相關(guān)影響因素分析[J];中華神經(jīng)外科雜志;2015年03期
2 董長征;趙文清;李文玲;岳向勇;郭韜;杜亞麗;康進(jìn)生;武江;梁傳棟;;局灶性腦皮質(zhì)發(fā)育不良致難治性癲癇病理分型和手術(shù)療效分析[J];中華神經(jīng)外科雜志;2010年03期
，本文編號：2355112
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