Abstract: Objective To investigate the long-term surgical outcome and safety of reoperation following resective surgeryin patients with refractory epilepsy.Methods Epilepsy patients who were admitted to our center from January 2011 to December 2018 for reoperation were retrospectively included.The surgical outcome of the patients was evaluated using Engel class and the surgery-related complications were observed and documented.Results A total of 32 patients were included,of whom2 hadhemispherotomy,9 had multiple lobe resection or disconnection and 21 had extended resection of epileptic foci restricted to a single lobe.Surgery-related perioperative complications included:subcutaneous effusion (one of which was combined with incisional infection)in 5,transient motor dysfunction or aphasiain 3,subdural effusion in one,intracranial infectionin one,and intracranial hemorrhage combined with hydrocephalus and right lower extremity motordysfunctionin one.2 cases were lost at the final follow-up,and the remaining 30 cases were followed up for a mean of 79.4±25.1 months (36-121 months).The postoperative outcomes including:13 (43.3%) were Engel I;7 (23.3%) wereEngel II;3 (10.0%) were Engel III;and 7 (23.3%) were Engel IV.There were no new surgery-related complications occurredduring the follow-up period.Conclusion The overall long-term surgical outcome and safety of reoperation for refractory epilepsy is good despite failure of the previous resective surgery.

Key words: Refractory epilepsy, Resective surgery, Reoperation, Surgical outcome

摘要： 目的 探讨难治性癫痫患者切除术后再次手术治疗的长期手术疗效和安全性。方法 回顾性纳入我中心2011年1月至2018年12月收治的再次行切除/离断手术治疗的癫痫患者,采用Engel分级标准评估术后疗效并随访手术相关并发症。结果 共纳入32例患者,手术方式包括大脑半球离断术2例、多脑叶切除/离断术9例和单脑叶癫痫灶扩大切除术21例。围手术期手术相关并发症包括:5例皮下积液(其中1例合并切口感染);3例短暂运动功能障碍或失语;1例硬膜下积液;1例颅内感染;1例颅内出血合并脑积水和右下肢运动功能障碍。末次随访有2例失随访,其余30例平均随访79.4±25.1个月(36~121个月),术后疗效按Engel分级为:EngelⅠ级13例(43.3%);EngelⅡ级7例(23.3%);Engel Ⅲ级3例(10.0%);Engel Ⅳ级7例(23.3%)。随访期内无新发手术相关并发症。结论 难治性癫痫切除性手术失败后,再次进行综合评估并手术,其总体的长期手术疗效和安全性较好。

关键词: 难治性癫痫, 切除手术, 再手术, 疗效