摘要目的 分析影响双侧颅骨修补术后癫痫发作的相关因素及预防措施.方法 回顾性分析2008年1月至2014年12月于解放军第101医院神经外科行双侧颅骨修补术的59例颅脑外伤患者,分为分次修补组(30例)和双侧同时修补组(29例),比较两组患者术后癫痫的发生率,并采用Mantel-Haenszed检验进一步分析修补面积、颅骨缺损时间、修补前格拉斯哥昏迷评分(GCS)以及是否同时行脑室-腹腔分流术对癫痫发生的影响.结果 双侧同时修补组癫痫发作共14例(48％),分次修补组6例(20％),两组之间的差异有统计学意义(P＜0.05).术前GCS评分＜13分和修补面积＞ 120 mm2的患者行双侧同时颅骨修补术后癫痫的发生率分别高于GCS评分＞13分和修补面积＜ 120 mm2的患者(均P＜0.05),颅骨缺损时间以及是否同时行脑室-腹腔分流术两组间差异无统计学意义(均P ＞0.05).缺损面积的大小和修补前GCS评分为术后癫痫发作的危险因素.结论 对于GCS评分＜13分和(或)双侧颅骨缺损面积＞120 mm2的患者,行分次颅骨修补术可降低癫痫的发生率,修补时限的延长、分流和修补手术同时进行并未增加癫痫发作的风险.

abstractsObjective To analyze of the related factors of influencing the epileptic seizure after bilateral cranioplasty and preventive measures.Methods Fifty-nine patients with craniocerebral trauma treated with bilateral cranioplasty at the Department of Neurosurgery,the 101st Hospital of PLA from January 2008 to December 2014 were analyzed retrospectively.They were divided into either a two-step repair group (n =30) or a bilateral simultaneous repair group (n =29),and the incidence of epilepsy was compared after procedure between the 2 groups.Mantel-Haenszed test was used to further analyze the effects of the size of repair area,the time length of skull defects,the Glasgow coma scale (GCS),and whether performing ventriculoperitoneal shunt simultaneously on the occurrence of epilepsy.Results A total of 14 patients (48％) experienced seizures in the bilateral simultaneous repair group and 6 (20％) in the two-step repair group.There was significant difference between the two groups (P ＜0.05).The incidence of epilepsy in patients with preoperative GCS ＜ 13 and the repairing area ＞ 120 mm2 after performing bilateral simultaneous cranioplasty was higher than those with GCS ＞ 13 and repairing area ＜ 120 mm2,respectively (all P ＜ 0.05).There were no significant differences in the time of skull defects and whether simultaneous operation with ventriculoperitoneal shunt or not between the 2 groups (all P ＞ 0.05).Conclusions For patients whose GCS ＜ 13 and/or bilateral skull defect area ＞120 mgh2,the two-step cranioplasty reduced the incidence of seizures,and the extension of repair time and simultaneous shunt + repair operation did not increase the risk of epileptic seizures.