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目的探讨并比较伽玛刀与手术在颞叶癫痫治疗中的临床疗效。方法某院于2000年1月～2009年1月对收治的颞叶癫痫患者分别采用伽玛刀与手术治疗,并比较两种治疗方法的临床疗效及并发症发生情况。结果两组患者经过积极治疗后,伽马刀组患者中满意36例,显著改善6例,良好7例,总有效率达87.50%;而手术组患者中满意40例,显著改善5例,良好2例,总有效率达94.00%;经统计学分析发现两组患者的满意率、显著改善率、良好率及总有效率差异均无统计学意义(χ2=3.21、0.01、2.46、1.31、1.31,P均﹥0.05)。伽马刀组患者中有2例患者在术后6～12个月出现精神症状,但是经过常规激素、甘露醇治疗后症状均消失,无病残和死亡病例;手术组患者在术后出现暂时性偏瘫2例,轻度同向视野缺损4例,硬膜外血肿1例(钻空外引流后完全恢复),记忆力减退2例。对两组的术后并发症进行统计学分析显示伽马刀组患者术后并发症发生率明显低于手术组,且差异有统计学意义(χ2=5.91,P=0.02)。而且伽马刀组患者中未发生致残病例,而手术组中出现2例暂时性偏瘫。结论手术治疗颞叶瘢痛的临床疗效稍微好于伽玛刀,但手术治疗具有死亡和致残的风险,而伽玛刀治疗颞叶癫瘸的疗效明确,且并发症少、轻微,但是治疗后部分患者有复发的可能,针对这部分患者可以在伽玛刀治疗失败后选择手术进行第2次治疗。
Objective To investigate and compare the clinical efficacy of gamma knife and surgery in the treatment of temporal lobe epilepsy. Methods A hospital from January 2000 to January 2009 for the treatment of temporal lobe epilepsy patients were treated with gamma knife and surgery, and compared the clinical efficacy and complications of the two treatment methods. Results After active treatment in both groups, 36 cases were satisfied with Gamma Knife group, 6 cases improved significantly, 7 cases were good, the total effective rate reached 87.50%; while those in operation group were satisfied with 40 cases, significantly improved in 5 cases 2 cases, the total effective rate of 94.00%; by statistical analysis found that two groups of patients satisfaction rate, significant improvement rate, good rate and total effective rate difference was not statistically significant (χ2 = 3.21,0.01,2.46,1.31,1.31 , P> 0.05). Gamma knife group of patients in 2 patients in 6 to 12 months after the onset of psychiatric symptoms, but after conventional hormones, mannitol symptoms disappeared, no disability and death cases; patients in the operation group after the temporary 2 cases of sexual hemiplegia, 4 cases of mild visual field defect, 1 case of epidural hematoma (complete recovery after drilling outside drainage), memory loss in 2 cases. The statistical analysis of the postoperative complications in the two groups showed that the incidence of postoperative complications in the gamma knife group was significantly lower than that in the surgical group (χ2 = 5.91, P = 0.02). In addition, there were no cases of disability in the Gamma knife group and 2 cases of transient hemiparesis in the operation group. Conclusions Surgical treatment of temporal lobe pain is slightly better than gamma knife surgery, but surgical treatment has the risk of death and disability. However, gamma knife treatment of temporal lobe epilepsy has a clear effect and few complications, but the treatment is mild After some patients have the possibility of recurrence, for this part of patients can choose the surgery after the failure of gamma knife treatment for the second treatment.