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目的回顾5例手术失败癫癎患者临床诊断与治疗经过,探讨失败原因,总结经验教训。方法与结果5例首次手术失败癫癎患者,男4例,女1例;年龄最小2岁7个月、最大24岁。其中胚胎发育不良性神经上皮瘤3例,海马硬化伴皮质发育不良2例。首次手术失败原因分别为病灶和(或)致癎灶切除不完全(3例)、颞叶内侧致癎灶切除不彻底(1例)和致癎灶定位错误或欠精确(1例)。均经再次手术联合抗癫癎药物或伽玛刀治疗获得较好预后,疗效评价达Engel标准Ⅰ级者4例,Ⅲ级者1例;谭启富标准达满意者4例,良好者1例。结论导致癫癎手术失败的原因可能与致癎灶切除不彻底有关。通过严格的术前评价施行再次手术不失为最佳纠正方法,并可获得良好效果。
Objective To review the clinical diagnosis and treatment of 5 cases of epilepsy patients with surgical failure, discuss the causes of failure and summarize the experience and lessons. Methods and Results 5 cases of first-time patients with epilepsy surgery failure, 4 males and 1 female; the youngest 2 years 7 months, maximum 24 years old. Including embryonic dysplastic neuroepithelioma in 3 cases, hippocampal sclerosis with cortical dysplasia in 2 cases. The causes of the first operation failure were incomplete lesion and / or excision of the foci (3 cases), incomplete removal of the foci (1 case) and misdirection (1 case) to the lesion. After reoperation combined with anti-epileptic drugs or gamma knife treatment to obtain a better prognosis, efficacy evaluation of Engel standard grade Ⅰ in 4 cases, Ⅲ grade in 1 case; Tan Qifu standard satisfied in 4 cases, good in 1 case. Conclusion The reason of the failure of epilepsy surgery may be related to incomplete resection of the fissure cavity. Re-operation through rigorous preoperative evaluation after all is the best way to correct, and get good results.