对于来说,LITT的修订:如果第一个治疗失败了,患者是否有可能接受第二次治疗?
Nolan Winslow1, Alexander Himstead1, Sumeet Vadera1
1University of California Irvine, 101 The City Drive, Orange, CA 92868, United States.
概括
重复激光间歇热疗法 (LITT) 或手术切除可以改善最初治疗失败的患者的自由度. 本综述强调了后续治疗耐火性的潜在益处.
科学领域:
- 神经外科 神经外科
- 发病学 (Epileptology) 是一个专业的学科.
- 最少侵入性手术的方法
背景情况:
- 医疗耐药性 presents一个重大挑战,手术切除提供了最好的机会抓获自由,但往往未充分利用.
- 激光间歇性热疗法 (LITT) 是一种微创手术选择,其疗效因潜在病理而异.
- 在初始失败的症LITT手术后,重复LITT或随后的手术干预的利用和结果没有得到充分的记录.
研究的目的:
- 审查医疗耐药性的初始LITT手术后接受后续手术治疗的患者的现有文献.
- 为了确定患者群体谁可能会从多次手术干预中获益最多的控制.
- 评估重复LITT和其他手术切除在实现发作自由方面的有效性.
主要方法:
- 在多个医学数据库中进行了全面的文献审查,遵守PRISMA指南.
- 包括的研究包括那些至少有五名患者接受LITT治疗和至少六个月的随访.
- 提取的数据包括临床变量,LITT后的控制率以及接下来接受的任何治疗的细节.
主要成果:
- 在接受LITT治疗的1734名患者中,46.4%的患者实现了无发作.
- 在拥有进一步手术数据的850名患者中,29.1%接受了持续性的后续干预,包括重复LITT (55.4%) 和手术切除 (41.9%).
- 在重复LITT后的51.2%的患者和随后的手术切除后的62.9%的患者实现了无发作. 洞穴形和下丘脑瘤显示LITT的疗效率更高.
结论:
- 虽然LITT在治疗中表现出有效性,但并非所有患者在最初的手术中都能摆脱发作.
- 重复LITT或随后的手术切除是改善持久性患者的控制的可行策略.
- 患者应被告知可能需要多次手术干预,以最大限度地实现长期无的机会.
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