贾琴　刘文科

[摘要] 目的 探討多学科团队综合治疗模式对脑海绵状血管畸形相关性癫痫（CCME）手术疗效的影响。 方法 选择2014年5月～2016年5月在华西医院接受手术治疗的153例CCME患者作为研究对象，将2014年5月～2015年5月组建多学科团队前就诊的73例CCME患者作为对照组，接受常规手术治疗；2015年6月～2016年5月组建多学科团队后的80例患者作为观察组，在多学科团队合作下进行综合诊疗。采用Engel分级及国内改良的评价方法对CCME术后癫痫疗效进行分析，比较两组并发症发生情况。 结果 观察组Engel分级、国内改良分级明显优于对照组，差异有统计学意义（P < 0.05）。观察组并发症发生率低于对照组，但差异有统计学意义（P > 0.05）。结论 多学科团队综合治疗模式对CCME的手术疗效起到重要作用，能够显著提高癫痫控制率，应在有条件的医疗单位进行推广应用。

[关键词] 脑海绵状血管畸形；癫痫；多学科团队；手术疗效

[中图分类号] R739.41 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0133-05

The clinical effect of multi-disciplinary team integrating model in the surgical treatment of cerebral cavernous malformation associated with epilepsy

JIA Qin1 LIU Wenke2

1.Department of Cardiology， West China Hospital， Sichuan University， Sichuan Province， Chengdu 610041， China；

2.Department of Neurosurgery， West China Hospital， Sichuan University， Sichuan Province， Chengdu 610041， China

[Abstract] Objective To investigate the clinical effect of multi-disciplinary team integrating model in the surgical treatment of cerebral cavernous malformation associated with epilepsy （CCME）. Methods From May 2014 to May 2016， 153 patients with CCME underwent surgical therapy in West China Hospital were selected as the research objects. Seventy-three patients with CCME before multidisciplinary teams establishment from May 2014 to May 2015 were considerd as the control group and received conventional surgical treatment， while from June 2015 to May 2016， 80 patients with CCME before multidisciplinary teams establishment were considerd as the observation group and received comprehensive diagnosis and treatment after multidisciplinary teams establishment. The effects of postoperative epilepsy on CCME were analyzed by Engel classification and improved evaluation methods in China. The postoperative complications between the two groups was compared. Results The Engel classification and improved evaluation methods in China in the observation group were significantly better than those of control group， with statistically significant differences （P < 0.05）. The incidence of complications in the observation group was lower than that of control group， but with-out statistically significant differences （P < 0.05）. Conclusion The multi-disciplinary team integrating model plays an important role in the surgical efficacy of CCME， can significantly increase the epilepsy control rate. It should be promoted and applicated in qualified medical units.

[Key words] Cerebral cavernous malformations； Epilepsy； Multidisciplinary team； Surgical outcome

脑海绵状血管畸形（cerebral cavernous malformation，CCM）是颅内常见的血管畸形之一，高达70%的幕上CCM可发生癫痫[1]。但CCM与癫痫的发生并非存在完全的因果关系，根据临床表现及脑电图结果将CCM与癫痫的关系分为三种类型：一是有确定的因果关系；二存在可能的因果关系；三是癫痫与CCM无关，CCM只是偶然发现[2]。CCM相关性癫痫（CCM associated epilepsy，CCME）包括前两类。有研究表明，术前癫痫症状持续时间越长，手术效果愈差[3]。CCME手术治疗涉及到多个环节，除了海绵状血管畸形病灶本身的切除，同时也需要对癫痫灶进行相应处理，术前诊断、术中手术配合及术后康复护理需要多学科协作，组建多学科团队是否会改善CCME手术疗效目前尚未见文献报道，本研究针对CCME专病组建多学科团队前后的手术疗效作一对比，明确多学科团队在CCME中的作用，为多学科团队在CCME这类疾病中的推广奠定基础。……