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目的:确定难治性颞叶癫痫患者进行选择性杏仁核-海马切除术（SAH）后生活质量改善达最小临床重要差异（MCID）的独立预测因子。方法:本研究为前瞻性队列研究，纳入了2016年8月至2018年8月上海交通大学医学院附属瑞金医院功能神经外科和神经内科收治的42例接受SAH手术的难治性颞叶癫痫患者，并对所有患者进行术前及术后18个月的癫痫患者生活质量量表31（QOLIE-31）的评估，采用多元Logistic回归分析患者术后生活质量改善达到MCID的独立预测因子。结果:42例难治性颞叶癫痫患者SAH术后QOLIE-31总分及各分量表评分均有显著改善，其中78.6%（33/42）达到生活质量改善的MCID标准。根据QOLIE-31总分，生活质量有明显改善的患者和无明显改善的患者，两组间蒙特利尔认知评估量表评分（n OR=0.081， 95%n CI 0.009~0.728， n P=0.020）、抑郁自评量表评分（n OR=0.107， 95%n CI 0.019~0.615， n P=0.016）、汉密尔顿抑郁量表评分（n OR=0.143， 95%n CI 0.025~0.806，n P=0.025）及术后癫痫完全控制（n OR=13.000， 95%n CI 2.194~77.037，n P=0.003）差异有统计学意义。在最终的多元Logistic回归模型中，对生活质量有显著改善达到MCID的独立预测因子为术前无抑郁诊断（校正n OR=10.528，95%n CI 1.195~92.783，n P=0.034）和术后无癫痫发作（校正n OR=9.669，95%n CI 1.103~84.734，n P=0.040）。生活质量显著改善达到MCID的敏感度和特异度分别为93.9%和77.8%，模型总准确率为90.5%。n 结论:术前无抑郁和术后无癫痫发作是难治性颞叶癫痫患者SAH术后生活质量显著改善达到MCID的独立预测因子。对难治性颞叶癫痫患者在术前应注意心理障碍的评估。“,”Objective:To determine the independent predictors of minimum clinically important differences (MCID) in quality of life in patients with refractory temporal lobe epilepsy (TLE) after selective amygdalohippocampectomy (SAH).Methods:Forty-two patients with refractory TLE undergoing SAH from August 2016 to August 2018, who admitted to the Department of Functional Neurosurgery and Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, were included. All patients were assessed with Quality of Life in Epilepsy Inventory-31 (QOLIE-31) before and 18 months after SAH. Multiple binary Logistic regression was used to analyze the independent predictors of quality of life improvement to MCID.Results:In 42 patients with refractory TLE, the total QOLIE-31 score and all subscales scores were significantly improved after SAH, and 78.6%(33/42) of them reached the MCID standard of quality of life improvement. According to the total score of QOLIE-31, there were significant differences in Montreal Cognitive Assessment score (n OR=0.081, 95%n CI 0.009-0.728, n P=0.020), Self-rating Depression Scale score (n OR=0.107, 95%n CI 0.019-0.615, n P=0.016), Hamilton Depression Scale score (n OR=0.143, 95%n CI 0.025-0.806, n P=0.025) and a complete postoperative seizure control (n OR=13.000, 95%n CI 2.194-77.037, n P=0.003) between patients with or without significant improvement in quality of life. In the final multivariate Logistic regression model, the independent predictors of significant improvement in quality of life to MCID were presurgical diagnosis without depression (adjustedn OR=10.528,95%n CI 1.195-92.783,n P=0.034) and postoperative seizure freedom (adjusted n OR=9.669,95%n CI 1.103-84.734,n P=0.040). The sensitivity and specificity of MCID were 93.9% and 77.8%, respectively. The total accuracy of the model was 90.5%.n Conclusions:Presurgical diagnosis without depression and postsurgical seizure freedom are independent predictors of significant improvement in quality of life to MCID in patients with refractory TLE after SAH. Patients with refractory TLE should be paid attention to the evaluation of psychological disorders before surgery.