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目的探讨脑电监测下联合手术方式治疗难治性癫痫的方法及其疗效。方法对58例难治性癫痫患者,根据其临床发作类型、体征、EEG、VEEG、CT、MRI、SPECT、认知量表进行术前评估,分别应用以下6种手术方式:①病灶切除术+变性脑组织切除术+MST+胼胝体切开术+前颞叶切除术+选择性海马杏仁核切除术+颅狭征浮动骨瓣整复术1例。②病灶切除术+变性组织切除术+选择性胼胝体切开术+MST4例。③病灶切除术+变性组织切除术+前颞叶切除术+海马杏仁核切除术+MST15例。④病灶切除术+变性组织切除术+MST+热灼术32例。⑤MST+热灼术+选择性胼胝体切开术5例。⑥MST+热灼术+双侧海马、杏仁核放射治疗术1例。结果随诊6个月～11年,根据1996年Engel疗效分级标准:Ⅰ级为26例、Ⅱ级为6例、Ⅲ级为20例、Ⅳ级为6例。Ⅰ级、Ⅱ级32例为临床治愈,Ⅲ级20例为好转,治愈率为55.2%,治愈好转率为89.7%。随访到31例患者智商与术前相比(t=2.706,P=0.011,P<0.05)有不同程度改善。结论根据癫痫放电区域,联合应用多种手术方式给以外科干预,可以收到较好的效果,同时可以不同程度改善脑认知功能。
Objective To investigate the method and efficacy of combined surgery for intractable epilepsy under electroencephalography (EEG). Methods Fifty-eight patients with intractable epilepsy were evaluated according to their type of seizure, signs, EEG, VEEG, CT, MRI, SPECT and cognitive scale. The following six surgical methods were applied: ① focal resection + One case of degenerative brain tissue resection + MST + corpus callosotomy + anterior temporal lobe resection + selective hippocampal appendectomy + cranial stenosis floating bone flap. ② focal resection + debridement + selective corpus callosum incision + MST4 cases. ③ focal resection + degeneration Tissue resection + anterior temporal lobectomy + hippocampus almond excision + MST15 cases. ④ focal resection + degeneration excision + MST + cautery in 32 cases. ⑤ MST + cauterization + selective corpus callosal incision in 5 cases. ⑥ MST + heat burning surgery + bilateral hippocampus, amygdala radiation therapy in 1 case. Results The follow-up ranged from 6 months to 11 years. According to the Engel’s 1996 efficacy classification criteria, there were 26 cases of grade I, 6 cases of grade II, 20 cases of grade III and 6 cases of grade IV. Grade Ⅰ, Ⅱ 32 cases of clinical cure, Ⅲ grade 20 cases improved, the cure rate was 55.2%, the cure rate was 89.7%. Follow-up to 31 patients with IQ improved compared with preoperative (t = 2.706, P = 0.011, P <0.05). Conclusion According to the epileptic discharge area, combined with a variety of surgical methods to give surgical intervention, you can receive better results, at the same time can improve brain cognitive function to varying degrees.