影响脑动静脉畸形显微手术疗效的临床因素分析  

Clinical factors affecting curative effect of microsurgery on patients with cerebral arteriovenous malformations

作　　者：胡观成 邹安琪[2] 刘小健[2] 屈家虎 

机构地区：[1]张家界市人民医院神经外科,427000 [2]南昌大学第一附属医院神经外科,南昌330006

出　　处：《中华神经医学杂志》2012年第9期899-903,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨影响脑动静脉畸形显微手术疗效的临床因素。方法收集自2003年1月1日至2009年12月31日南昌大学第一附属医院神经外科、张家界市人民医院神经外科显微外科手术治疗的111例脑动静脉畸形患者的临床资料，以术后7d、术后6月改良的Rankin量表神经功能状态评分为术后近期及远期疗效标准，通过Logistic回归分析检验患者的性别、年龄、颅内出血、畸形血管团位置、畸形血管团大小、深静脉引流、Spetzler-Martin分级及动脉瘤等因素对患者术后近期和远期疗效的影响。结果术后近期有29例（26．1％）患者出现了新的神经功能障碍。单因素和多因素分析均表明，无颅内出血、有深静脉引流、畸形血管团大、畸形血管团位于功能区、Spetzler-Martin分级高及伴发动脉瘤与术后近期患者出现新的神经功能缺损呈显著相关性（P〈0．05），性别、年龄与术后近期患者出现新的神经功能缺损无显著相关性（p〉0．05）。Spetzler．Martin分级I级、Ⅱ级、Ⅲ级患者术后7d与术后6月的神经功能状态评分比较差异均有统计学意义（氏0．05）。结论对于有深静脉引流、病灶位于功能区、畸形血管团大、无颅内出血及伴发动脉瘤的患者。术后近期容易出现新的神经功能缺损。术前对患者Spetzler-Martin分级程度的确定可对进一步的治疗方案起指导作用。Objective To investigate the clinical factors influencing the treatment efficacy of microsurgery on patients with cerebral arteriovenous malformations （AVMs）. Methods One hundred and eleven patients, admitted to our hospitals from January 1, 2003 to December 31, 2009 and underwent microsurgical cerebral AVMs resection were chosen in our study; their clinical data were retrospectively analyzed. The functional neurological status was classified with modified Rankin scale 7 d and 6 months after surgery. Binary logistic regression models were applied to test the effect of patient gender, age, intra-cerebral hemorrhage, and the size, deep venous drainage pattern and location of AVMs on long-term and short-term treatment efficacy. Results Twenty-nine patients （26.1%） showed new neurological deficits 7 d after the surgery. Univariate analysis and multivariate analysis demonstrated that deep venous drainage, eloquent location and large size of AVMs, high Spetzler-Martin grading aneurysms and no intra-cerebral hemorrhage were significantly associated with new early neurological deficits （P〈0.05）, while gender and age of the patients had no significant association with new early neurological deficits （P〉0.05）. The scores of neurological status scale in patients with Spetzler-Martin grading I, II and III were significantly different between 7 d and 6 months after the surgery （P〈0.05）. Conclusion AVMs patients having deep venous drainage, eloquent location and large size of AVMs, and having aneurysm and intra-cerebral hemorrhage may be the risk factors of new early neurological deficit after microsurgical resection; analyzing the Spetzler-Martin grading before surgery can help to determine the treatment options.

关 键 词：动静脉畸形 显微外科手术 神经功能障碍 危险因素 

分 类 号：R743.4[医药卫生—神经病学与精神病学]