摘要目的 分析采用致痫灶切除手术治疗的药物难治性癫痫(DRE)患者的致病灶定位、病理特点及长期疗效.方法 回顾性纳入2001年4月至2016年12月首都医科大学宣武医院功能神经外科行切除手术治疗的DRE患者,共2 424例.分析致痫灶的定位情况,分2个阶段随访术后≥1年者的癫痫完全无发作率.结果 2 424例患者中,MRI显示有明确病灶者1 299例(53.6％),1 125例(46.4％)未见明确病灶;共1 007例(41.5％)行颅内电极埋置术,其中65.5％(660例)为MRI未见明确病灶者;颞叶癫痫(TLE)手术1 030例(42.5％)、非颞叶癫痫(ETLE)手术1 394例(57.5％);常见的病理类型为局灶性皮质发育不良909例(37.5％)、海马硬化429例(17.7％)、瘢痕性脑回381例(15.7％)及低级别肿瘤223例(9.2％)等,其中12.5％(303例)伴有双重病理改变.1 424例(58.7％)随访≥1年,其中第1阶段(2001年4月至2012年7月的患者)随访的846例中,术后第1、3、5年的无发作率分别为64.7％(547/846)、52.5％(241/459)及49.6％ (119/240),其中TLE者分别为57.9％ (210/363) 、57.8％ (108/187)及56.3％ (58/103),ETLE者分别为59.4％(287/483)、47.8％(130/272)及46.7％ (64/137);178例(21.0％,178/846)出现手术并发症;第2阶段(2012年8月至2015年9月的患者)随访的578例中,术后第1、3年完全无发作率分别为64.7％ (374/578)、57.3％ (133/232),其中TLE者为71.4％ (187/262)、66.4％ (64/95),ETLE者为59.5％ (188/316)、51.1％ (70/137).2阶段术后1、3年总体无发作率比较,差异均无统计学意义(均P＞0.05);第2阶段术后1年TLE者的无发作率优于第1阶段(57.9％对比71.4％,P=0.001).结论 颅内电极埋置仍是致痫灶定位的重要手段.尽管随时间延长手术疗效有所减退,但总体TLE和ETLE患者均可获得长期稳定的手术疗效.

abstractsObjective To summarize the epileptogenic localizations,pathological findings and longterm surgical outcomes of patients with refractory epilepsy at a single center during past 15 years.Methods A totalof 2 424 patients who underwent epilepsy surgeries at Department of Functional Neurosurgery between April 2001 and December 2016 were included in this retrospective study.The traits of epileptogenic localization were analyzed.Outcomes of all patients who were followed up longer than 1 year post surgeries were studied in two stages,and the rate of seizure free was calculated.Results Among all 2 424 patients,1 299 (53.6％) had obvious lesions on MRI.There were 1 007 (41.5％) patients who underwent intracranial electrode placement and 65.5％ of those had no definite lesions on MRI.There were 1 030 (42.5％) cases who were diagnosed as temporal lobe epilepsy (TLE) and 1 394 (57.5％) diagnosed as extratemporal lobe epilepsy (ETLE).The common pathological types included focal cortical dysplasia (37.5％,909),mesial temporal sclerosis (17.7％,429),ulegyria (15.7％,381) and low grade tumor (9.2％,223).There was a double pathological change in 303 (12.5％) patients.A total of 1 424 (59.0％) patients were followed up for more than 1 year post surgery.At the first stage of follow-up (April 2001 to July 2012),846 patients completed follow-up lasting at least 1 year.The seizure-free rate was 64.7％ (547/846) at 1 year,52.5％ (241/459) at 3 years and 49.6％ (119/240) at 5 years post surgery.For the patients with TLE,the seizurefree rate was 57.9％ (210/363) at 1 year,57.8％ (108/187) at 3 years and 56.3％ (58/103) at 5 years post surgery.For the patients with ETLE,the seizure-free rate was 59.4％ (287/483) at 1 year,47.8％ (130/272) at 3 years and 46.7％ (64/137) at 5 years post operation.At the second stage of follow-up (August 2012 to September 2015),578 patients completed follow-up lasting at least 1 year.The seizure-free rate was 64.7％ (374/578) at 1 year and 57.3％ (133/232) at 3 years post surgery.For the patients with TLE,the seizure-free rate was 71.4％ (187/262) at 1 year and 66.4％ (64/95) at 3 years post operation.For patients with ETLE,the seizure-free rate was 59.5％ (188/316) and 51.1％ (70/137) at 1 year and 3 years post operation respectively.However,the difference in the seizure free rate was significant only at the first year post surgery in the patients with TLE between the 2 stages (57.9％ vs.71.4％,P =0.001),and there was no significant difference afterwards.Conclusions Long-term intracranial recording seems to be indispensable for identification of epileptogenic focus for some patients.Although surgical efficacy might decrease to some extent with extension of postoperative time,surgical treatment is beneficial and postoperative outcome is relatively stable for patients with either temporal or extratemporal epilepsy.