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目的探讨成人幕上脑胶质母细胞瘤癫痫患病率及其影响因素。方法回顾性分析2004～2012年间在本院持续治疗并死亡的18岁以上幕上脑胶质细胞瘤117例患者的临床资料,统计患者第一次手术(first timeoperation,FTO)前、后各阶段癫痫的发病率和患病率。分析癫痫的发病情况和影响因素。结果患者第一次手术前有癫痫症状的患者21例(17.95%),至死亡前出现癫痫发作患者共计84例(71.79%),其中FTO后15个月后活动性癫痫达到80%以上。肿瘤部位对FTO前及术后癫痫发作有明显影响,其中颞叶和额叶病灶癫痫发生率最高。病人年龄、性别、病程、手术治疗次数、放疗方式及化疗药物对患者出现癫痫发作无明显影响。FTO后1月内术前有癫痫发作的21例患者中有10例出现癫痫,全切除的胶质母细胞瘤患者癫痫发病率显著低于未全切除组(P=0.0478)。FTO前无癫痫的胶质母细胞瘤患者术后预防应用AEDs1～6个月较未用AEDs者新发癫痫明显减少(P<0.05)。结论胶质母细胞瘤患者的癫痫发病率高,治疗困难,手术全切除可以减少术前癫痫的术后癫痫发作。
Objective To investigate the prevalence of epilepsy in adult supratentorial glioblastoma and its influencing factors. Methods The clinical data of 117 patients with supratentorial supratentorial glioblastoma over 18 years old who underwent continuous treatment and died in our hospital from 2004 to 2012 were retrospectively analyzed. Before and after the first operation (FTO) Epilepsy morbidity and prevalence. Analysis of the incidence of epilepsy and influencing factors. Results Twenty-one patients (17.95%) had epilepsy before the first surgery. A total of 84 patients (71.79%) were seizures before death, and the activity of epilepsy was more than 80% 15 months after FTO. Tumor site before and after FTO seizures have a significant impact, including the temporal lobe and frontal lobe lesions the highest incidence of epilepsy. The patient’s age, sex, course of disease, number of surgical treatment, radiotherapy and chemotherapeutic drugs had no significant effect on seizures in patients. Epilepsy occurred in 10 out of 21 patients with preoperative epileptic seizures within 1 month after FTO. The overall incidence of epilepsy was significantly lower in patients with glioblastoma than in those without resection (P = 0.0478). Patients with FTO without glioblastoma had significantly fewer new-onset epilepsy (P <0.05) after 1 to 6 months of AEDs prophylaxis than those without AEDs. Conclusion Glioblastoma patients with high incidence of epilepsy, treatment difficulties, total resection can reduce preoperative epilepsy postoperative epileptic seizures.