外伤性颈内动脉海绵窦瘘的可脱性球囊栓塞治疗  

Embolization treatment with detachable balloon for traumatic carotid-cavernous fistulas

作　　者：俞学斌[1] 陈左权[2] 金国良[1] 赵振华[1] 

机构地区：[1]绍兴市人民医院神经外科,312000 [2]上海市第六人民医院神经外科

出　　处：《中华创伤杂志》2012年第4期328-331,共4页Chinese Journal of Trauma

摘　　要：目的探讨外伤性颈内动脉海绵窦瘘（traumaticcarotid-cavernousfistulas，TCCF）可脱性球囊栓塞术的技术要点并客观评价其治疗效果。方法以可脱性球囊栓塞治疗59例TCCF，共进行栓塞术64次。随访时间3个月-2年。结果48例成功闭塞瘘口且保留颈内动脉通畅，颈内动脉通畅率为81％；11例瘘口及颈内动脉被同时闭塞。5例在治疗后3d内复发（复发率为8％），再次行栓塞术，其中1例出现栓塞后失明，再次行球囊栓塞后成功闭塞，但视力未恢复；1例术后3d出现脑内血肿，急诊再次行栓塞，闭塞颈内动脉和瘘口，但左侧肢体轻瘫。结论以可脱性球囊栓塞是治疗TCCF的可靠方法，具有损伤小、安全性高的特点；术后应严密观察病情，若出现复发症状，应及时复查脑血管造影及头颅CT，急诊处理复发的TCCF。Objective To investigate the main technical points of detachable balloon in management of traumatic carotid-cavernous fistulas （TCCF） and evaluate objectively the clinical outcome. Methods A total of 59 patients with TCCF were treated with detachable balloons, which involved 64 embolization procedures. Follow-up ranged from 3 months to 2 years. Results Forty-eight patients with TCCF （81%） were successfully occluded with patency of internal carotid artery. The rest 11 patients were obstructed in both the fistula and the internal carotid artery. Recurrent TCCF was found within three days after embolization in five patients （ with a recurrence rate of 8% ） who underwent further emboliza- tion, of whom one patient went blind after the procedure and the eyesight showed no recovery even after another embolization with balloon for successful occlusion of the fistula ; one patient presented with intrac- erebral hematoma at day 3 postoperatively and underwent emergency embolization again to occlude the in- ternal carotid artery and fistula, with slight paralysis of the left limb. Conclusions Embolization of TCCF with detachable balloon is a reliable treatment, which is characterized by slight injury and high safety. However, the disease＇ s development should be strictly observed after the treatment. In the case of recurrence of symptoms, brain angiography and CT scanning should be rechecked timely and emergency treatment should be performed.

关 键 词：脑损伤 颈动脉海绵窦瘘 栓塞 可脱性球囊 

分 类 号：R654.3[医药卫生—外科学]