• 1 四川大學(xué)華西醫(yī)院神經(jīng)外科(成都，610041);2 都江堰市醫(yī)療中心神經(jīng)外科;

【摘要】　目的　 探討難治性癲癇不同類型手術(shù)的預(yù)后與病程長(zhǎng)短有無(wú)相關(guān)關(guān)系。　方法　 回顧性分析2005年1月-2009年12月在四川大學(xué)華西醫(yī)院神經(jīng)外科進(jìn)行難治性癲癇手術(shù)的143例患者，根據(jù)Engel分級(jí)對(duì)預(yù)后進(jìn)行評(píng)估，分別分析各類型手術(shù)不同病程時(shí)間之間的預(yù)后差異以及相關(guān)關(guān)系。　結(jié)果　 不同病程組顳葉手術(shù)和顳葉合并顳葉外手術(shù)的預(yù)后差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05），兩者之間無(wú)相關(guān)關(guān)系；顳葉外手術(shù)的預(yù)后在不同病程組間差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05），兩者之間呈負(fù)相關(guān)。　結(jié)論　 顳葉外癲癇手術(shù)的預(yù)后與病程存在相關(guān)關(guān)系；病程越短，預(yù)后越好。
【Abstract】　Objective　 To discuss the relationship between prognosis of different intractable epilepsy surgeries and the disease course.　Methods　 A total of 143 patients who had undergone surgeries for intractable epilepsy in the Neurosurgery Department of West China Hospital of Sichuan University from 2005 to 2009 were enrolled, and the prognosis with different disease course were assessed based on the Engel classification.　Results　 Between different disease duration groups, the difference between the prognosis of the temporal surgery and the surgery of temporal lobe combined with other lobes was not statistically significant (P gt;0.05), which indicated no relationship between the disease course and the prognosis. However, the difference between the prognosis of the surgeries outside the temporal lobe was statistically significant (P lt;0.05), which showed that patients with a longer disease course had a worse prognosis.　Conclusion　 The prognosis of the epilepsy surgery outside the temporal lobe is correlated with the disease course. The shorter course has a better prognosis after surgery.

引用本文： 李良,曾義軍,陳建斌,王強(qiáng)平,雷町. 難治性癲癇不同類型手術(shù)預(yù)后與病程的相關(guān)關(guān)系分析. 華西醫(yī)學(xué), 2011, 26(2): 201-203. doi: 復(fù)制

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5. 　Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy[J]. N Engl J Med, 2001, 345(5): 311-318.
6. 　Engel J Jr. Surgical treatment of the epilepsies[M]. 2nd ed. New York: Raven Press, 1993: 609-621.
7. 　Engel J Jr, Wiebe S, French J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons[J]. Neurology, 2003, 60(4): 538-547.
8. 　Mohanraj R, Brodie MJ. Diagnosing refractory epilepsy: response to sequential treatment schedules[J]. EurJ Neurol, 2006, 13(3): 277-282.
9. 　Stephen LJ, Kelly K, Mohanraj R, et al. Pharmacological outcomes in older people with newly diagnosed epilepsy[J]. Epilepsy Behav, 2006, 8(2): 434-437.
10. 　Olivier A. Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy[J]. Can J Neurol Sci, 2000, 27(Suppl 1): S68-S76.
11. 　Olivier A. Temporal resections in the surgical treatment of epilepsy[J]. Epilepsy Res, 1992, 5(Suppl 1): 175-188.
12. 　Engel J Jr, Wiebe S, French J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy[J]. Epilepsia, 2003, 44(6): 741-751.
13. 　Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis[J]. Brain, 2005, 128(Pt 5): 1188-1198.
14. 　Pomata HB, Gonzalez R, Bartuluchi M, et al. Extratemporal epilepsy in children: candidate selection and surgical treatment[J]. Childs Nerv Syst, 2000, 16(12): 842-850.
15. 　Siegel AM, Cascino GD, Meyer FB, et al. Surgical outcome and predictive factors in adult patients with intractable epilepsy and focal cortical dysplasia[J]. Acta Neurol Scand, 2006, 113(2): 65-71.
16. 　Lowe NM, Eldridge P, Varma T, et al. The duration of temporal lobe epilepsy and seizure outcome after epilepsy surgery[J]. Seizure, 2010, 19(5): 261-263.
17. 　Dlugos DJ. The early identification of candidates for epilepsy surgery[J]. Arch Neurol, 2001, 58(10): 1543-1546.
  1. 1.
  2. 2. 　Wang WZ, Wu JZ, Wang DS, et al. The prevalence and treatment gap in epilepsy in China: an ILAE/IBE/WHO study[J]. Neurology, 2003, 60(9): 1544-1545.
  3. 3. 　譚啟富, 胡志剛. 癲癇外科治療在低收入人群中的策略[J]. 實(shí)用醫(yī)院臨床雜志, 2009, 6(4): 9-11.
  4. 4. 　Kwan P, Brodie MJ. Definition of refractory epilepsy: defining the indefinable?[J]. Lancet Neurol, 2010, 9(1): 27-29.
  5. 5. 　Wiebe S, Blume WT, Girvin JP, et al. A randomized, controlled trial of surgery for temporal-lobe epilepsy[J]. N Engl J Med, 2001, 345(5): 311-318.
  6. 6. 　Engel J Jr. Surgical treatment of the epilepsies[M]. 2nd ed. New York: Raven Press, 1993: 609-621.
  7. 7. 　Engel J Jr, Wiebe S, French J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy: report of the Quality Standards Subcommittee of the American Academy of Neurology, in association with the American Epilepsy Society and the American Association of Neurological Surgeons[J]. Neurology, 2003, 60(4): 538-547.
  8. 8. 　Mohanraj R, Brodie MJ. Diagnosing refractory epilepsy: response to sequential treatment schedules[J]. EurJ Neurol, 2006, 13(3): 277-282.
  9. 9. 　Stephen LJ, Kelly K, Mohanraj R, et al. Pharmacological outcomes in older people with newly diagnosed epilepsy[J]. Epilepsy Behav, 2006, 8(2): 434-437.
  10. 10. 　Olivier A. Transcortical selective amygdalohippocampectomy in temporal lobe epilepsy[J]. Can J Neurol Sci, 2000, 27(Suppl 1): S68-S76.
  11. 11. 　Olivier A. Temporal resections in the surgical treatment of epilepsy[J]. Epilepsy Res, 1992, 5(Suppl 1): 175-188.
  12. 12. 　Engel J Jr, Wiebe S, French J, et al. Practice parameter: temporal lobe and localized neocortical resections for epilepsy[J]. Epilepsia, 2003, 44(6): 741-751.
  13. 13. 　Téllez-Zenteno JF, Dhar R, Wiebe S. Long-term seizure outcomes following epilepsy surgery: a systematic review and meta-analysis[J]. Brain, 2005, 128(Pt 5): 1188-1198.
  14. 14. 　Pomata HB, Gonzalez R, Bartuluchi M, et al. Extratemporal epilepsy in children: candidate selection and surgical treatment[J]. Childs Nerv Syst, 2000, 16(12): 842-850.
  15. 15. 　Siegel AM, Cascino GD, Meyer FB, et al. Surgical outcome and predictive factors in adult patients with intractable epilepsy and focal cortical dysplasia[J]. Acta Neurol Scand, 2006, 113(2): 65-71.
  16. 16. 　Lowe NM, Eldridge P, Varma T, et al. The duration of temporal lobe epilepsy and seizure outcome after epilepsy surgery[J]. Seizure, 2010, 19(5): 261-263.
  17. 17. 　Dlugos DJ. The early identification of candidates for epilepsy surgery[J]. Arch Neurol, 2001, 58(10): 1543-1546.