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目的探讨改良功能性大脑半球切除术治疗婴儿偏瘫伴顽固性癫疒间的疗效。方法总结9例小骨窗经侧裂功能性大脑半球切除术病人的临床资料。手术均采用侧裂表面4cm×5cm骨窗开颅,分开侧裂后经皮质进入侧脑室,完成功能性大脑半球切除手术。结果与常规功能性大脑半球切除术相比,手术时间明显缩短(平均4.2h)、术中需要输血比例(22.2%)降低。随访时间平均2.1年,Engel癫疒间疗效分级Ⅰ级6例,Ⅱ级2例,Ⅲ级1例。偏瘫改善6例(66.7%),语言改善5例(55.6%),行为改善8例(88.9%)。结论小骨窗经侧裂功能性大脑半球切除术,癫疒间控制效果满意,且可缩短手术时间,减少术中出血。
Objective To explore the therapeutic effect of modified functional hemispherectomy on infantile hemiplegia and intractable epilepsy. Methods The clinical data of 9 cases of small bone window with functional hemifacial hemifacial ablation were summarized. Operative side surface of 4cm × 5cm bone craniotomy craniotomy, after separate lateral fissure into the lateral cerebral ventricle to complete functional hemisphere surgery. Results Compared with conventional functional hemispherectomy, the operation time was significantly shortened (average 4.2 hours) and the proportion of blood transfusions required (22.2%) during operation was decreased. The average duration of follow-up was 2.1 years. Engel’s epilepsy was grade Ⅰ in 6 cases, grade Ⅱ in 2 cases and grade Ⅲ in 1 case. Hemiplegia improved in 6 cases (66.7%), speech improvement in 5 cases (55.6%), behavior improvement in 8 cases (88.9%). Conclusion Small bone window through the fissure functional hemispherectomy, epilepsy control effect is satisfactory, and can shorten the operation time and reduce intraoperative bleeding.