[1]齐雪岭　姚　坤　段泽君　翟　锋　周　健.癫痫病人海马电凝热灼术中电凝功率与海马传导纤维病理改变相关性分析[J].中国临床神经外科杂志,2017,(06):382-385.[doi:10.13798/j.issn.1009-153X.2017.06.005]
　QI Xue-ling,YAO Kun,DUAN Ze-jun,et al.Correlation between power of hippocampal electrocoagulation and pathological changes in hippocampal conduction fibers in patients with temporal lobe epilepsy[J].,2017,(06):382-385.[doi:10.13798/j.issn.1009-153X.2017.06.005]
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癫痫病人海马电凝热灼术中电凝功率与海马传导纤维病理改变相关性分析()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2017年06期
页码:
382-385
栏目:
论著
出版日期:
2017-06-25

文章信息/Info

Title:
Correlation between power of hippocampal electrocoagulation and pathological changes in hippocampal conduction fibers in patients with temporal lobe epilepsy
文章编号:
1009-153X（2017）06-0382-04
作者:
齐雪岭　姚　坤　段泽君　翟　锋　周　健
100093 北京，首都医科大学三博脑科医院病理科（齐雪岭、姚　坤、段泽君），神经外科（翟　锋、周　健）
通讯作者：周　健，E-mail：zhoujian5151@163.com
Author(s):
QI Xue-ling1;  YAO Kun1;  DUAN Ze-jun1;  ZHAI Feng2;  ZHOU Jian2.
1. Department of Pathology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China;
2. Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
关键词:
颞叶癫痫; 海马电凝热灼术; 海马传导纤维病理改变
Keywords:
Temporal lobe epilepsy;  Hippocampal electro-coagulation;  Pathological changes;  Curative effects
分类号:
R 742.1; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2017.06.005
文献标志码:
A
摘要:
目的 观察不同功率的海马电凝热灼术（HEC）损伤海马浅层所引起的海马横行传导纤维的病理形态学改变，探讨最佳功率应用于热灼海马分子层来控制颞叶癫痫（TLE）发作的可行性，为HEC治疗TLE寻求可靠的理论依据。方法 对20例TLE病人的海马进行电凝热灼，输出功率为3、5、7 W；然后切除海马。对切除的海马进行病理形态学观察分析，并对比热灼损伤深度。结果 热灼后海马的病理形态学表现主要分为三层：浅表分子层的热凝固损伤；损伤部位分子层的水平神经元核固缩；损伤部位与正常脑组织之间的水肿带；而锥体细胞及齿状回颗粒细胞层结构相对正常。4例热灼功率3 W，平均损伤深度为0.335 mm；7例为5 W，平均损伤深度为0.556 mm；9例为7 W，平均损伤深度为1.290 mm。锥体细胞深度在表面以下1.786~1.995 mm，平均1.836 mm。结论 HEC可使海马分子层的横行纤维变性、断裂，热灼功率7 W效果最佳，不但可阻止癫痫放电水平方向的同步化和传播，同时保留海马的记忆功能。
Abstract:
Objective To observe the morphological changes in the hippocampal transverse conduction fibers induced by different power coagulation lesions in the hippocampus in order to provide a reliable basis for treatment of temporal lobe epilepsy (TLE) by the electrocoagulation of hippocampus. Methods Twenty patients with TLE were treated by electrocoagulation of hippocampi with output power of 3, 5 and 7 watts. The morphology of the resected hippocampi was observed under microscope after the elctrocoagulation. Results The hippocampi after the coagulation histomorphologically were mainly divided into three layers, i.e. superficial molecular layer injured by electrocoagulation, horizontal neurons layer with nuclear pyknosis in the lesion site and edema zone between the injured site and normal brain tissues. The hippocampal pyramidal cells and dentate granular cell layer structure were relatively normal. The average depth injured by 7 watts electrocoagulation power was 1.290 mm in 9 patients, by 56 mm in 7, and by 3 watts 0.335 mm in 4. The depth of thermal injury to the hippocampus increased significantly with increase in the electrocoagulation power. Conclusions The degeneration and fracture of hippocampal molecular layer of transverse fibers can be induced by the electrocoagulation. The electrocoagulation with output of 7 watts can produce the best curative effects including the prevention of the epileptic discharge level synchronization and dissemination and retaining the hippocampal memory function.

参考文献/References:

[1] Terra-Bustamante VC, Inuzuca LM, Fernandes RM. Tem- poral lobe epilepsy surgery in children and adolescents: clinical characteristics and post-surgical outcome [J]. Seizure, 2005, 14: 274-281.
[2] Bell ML, Rao S, So EL, et al. Epilepsy surgery outcomes in temporal lobe epilepsy with a normal MRI [J]. Epilepsia, 2009, 50(9): 2053-2060.
[3] 周　健，翟　锋，栾国明. MRI阴性的颞叶癫痫的外科治 疗[J]. 中华神经外科杂志，2011，27（12）：1241-1242.
[4] Engel JJ, Van Ness P, Rasmussen TB, et al. Outcome with respect to epileptic seizures [M]. In: Surgical Treatment of the Epilepsies. New York: Raven Press, 1993. 609-621.
[5] Shimizu H, Kawai K, Sunaga S, et al. Hippocampal transec- tion for treatment of left temporal lobe epilepsy with preser- vation of verbal memory [J]. J Clin Neurosci, 2006, 13(3): 322-328.
[6] Sunaga S, Morino M, Kusakabe T, et al. Efficacy of hippo- campal transection for left temporal lobe epilepsy without hippocampal atrophy [J]. Epilepsy Behav, 2011, 21: 94-99.
[7] 栾国明，张伟丽，阎　丽，等. 脑皮层热灼治疗功能区癫痫 的可行性研究[J]. 中华神经外科杂志，1999，15：329-331.
[8] Luan G, Sun Z, Bai Q, et al. Surgical treatment of intractable epilepsy combined with bipolarelectrocoagulation on func- tional cortex [J]. Stereotact Funct Neurosurg, 2001, 77(1-4): 233-238.
[9] 栾国明，张伟丽，孙异临，等. 电凝热灼和激光照射猴脑浅 表皮层后其形态学改变的对比研究[J]. 立体定向和功能 性神经外科杂志，2002，15（4）：187-191.
[10] 栾国明，李云林，闫　丽，等. 痫灶切除辅助性脑皮层横行 纤维热灼治疗功能区癫痫的临床研究[J]. 中华神经外科 杂志，2002，18（4）：209-212.
[11] 钱若兵，傅先明，喻　廉，等. 立体定向病灶切除联合皮层 热灼术治疗起源于中央区的癫痫[J]. 临床神经外科杂 志，2004，1（4）：170-172.
[12] Cui ZQ, Luan GM, Zhou J. Pure bipolar electro-coagulation on functional cortex in the treatment of epilepsy involving eloquent areas [J]. Epilepsy Res, 2012, 99: 139-146.
[13] 朴月善，陈莉，付永娟，等.癫痫相关局灶性皮质发育不良 的临床病理学研究[J]. 中华病理学杂志，2007，36（3）: 150-154.
[14] Penfield W, Baldwin M. Temporal lobe seizures and thete- chnic of　subtotal temporal lobectomy [J]. Ann Surg, 1952, 136: 625-634.
[15] Squire LR. Memory and the hippocampus: a synthesis from findings with rats, monkeys, and humans [J]. Psychol Rev, 1992, 99(2): 195-231.
[16] Gleissner U, Helmstaedter C, Schramm J, et al. Memory out- come after selective amygdalohippocampectomy: a study in 140 patients with temporal lobe epilepsy [J]. Epilepsia, 2002, 43: 87-95.
[17] Helmstaedter C, Petzold I, Bien CG. The cognitive consequ- ence of resecting nonlesional tissues in epilepsy surgery-- results from MRI- and histopathology negative patients with temporal lobe epilepsy [J]. Epilepsia, 2011, 52(8): 1402- 1408.
[18] Wyler AR, Wilkus RJ, Rostad SW, et al. Multiple subpial transections for partial seizures in sensorimotor cortex [J]. Neurosurgery, 1995, 37: 1122-1128.

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备注/Memo

备注/Memo:
基金项目：北京市科学技术委员会重点课题（Z131107002213012）
更新日期/Last Update: 2017-06-25