介入栓塞治疗硬脊膜动静脉瘘的疗效分析  

Feasibility and efficiency of embolization of spinal dural arteriovenous fistula

作　　者：张鸿祺[1] 柳江[2] 王建生[2] 支兴龙[1] 张鹏[1] 卞立松 何川[1] 叶明[1] 王志潮[2] 李萌[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院神经外科,北京100053 [2]北京市海淀医院神经外科

出　　处：《中华外科杂志》2013年第3期216-220,共5页Chinese Journal of Surgery

基　　金：国家自然科学基金资助项目（30772236,81171165）;首都临床特色应用研究资助项目（z121107001012107）

摘　　要：目的探讨介入栓塞硬脊膜动静脉瘘（SDAVF）的可行性和有效性。方法自2010年12月至2012年5月共治疗104例SDAVF患者，选择符合条件的26例进行栓塞治疗。男性22例，女性4例，男女比例5．5：1；年龄34～81岁，平均55．9岁。SDAVF分别位于胸段10例、腰段9例、骶段7例。主要表现为双下肢进行性麻木无力和大小便障碍，病程1～156个月，平均17．1个月。栓塞材料使用ONYX一18液态栓塞剂或ubran-2外科胶，未完全栓塞的患者，择期行手术治疗。治疗后3个月行脊髓功能评价和MRI检查，6个月行脊髓功能评价、MRI和脊髓血管造影检查。结果26例患者中有15例达到即刻完全栓塞的影像学标准。使用ONYX-18栓塞20例，14例完全栓塞；应用Glubran栓塞6例，仅1例完全栓塞。10例胸段患者中仅3例获得完全栓塞，16例腰骶段患者中，12例完全栓塞。未完全栓塞的患者2周内均行手术治疗。所有病例于术后3和6个月复查MRI，6个月复查DSA。完全栓塞患者症状术后即刻均有不同程度的好转，6个月随访时肌力和大小便功能均有较明显的改善，MRI显示脊髓水肿消失，蛛网膜下腔的迂曲血管影消失。复查脊髓DSA均未见病变残留或复发。所有经过栓塞治疗的患者，术后未出现症状加重或新发症状。结论部分SDAVF，尤其病变位于腰骶部的患者，适宜栓塞治疗，栓塞的材料和方法需要进一步探讨。Objective To evaluate the feasibility and efficiency of embolization of spinal dural arteriovenous fistula （SDAVF）. Methods From December 2010 to May 2012, there were 104 cases of SDAVF were treated, and 26 cases were selected to be treated with embolization. The inclusion criteria was as follows ： （ 1 ） No anterior or posterior spinal artery originated from the fistula segment; （2） The segmental artery can be catheterized with guiding or micro catheter; （3） High flow in fistula; （4） Patient＇s situation was not suitable for surgery or general anesthesia. Among 26 cases, there were 22 male and 4 female patients, the average age was 55.9 years （ranged from 34 to 81 years）. The locations of SDAVF were 10 cases in thoracic, 9 in lumbar and 7 in sacral segment. The main symptoms were progressive numbness and weakness in both lower extremities, most cases accompanied with difficulties in urination and defecation. The average history was 17.1 months （from 1 to 156 months）. ONYX-18 liquid embolic agent or Glubran-2 surgical glue were used as embolic material. The patients not cured with embolization were treated with surgery in the following 1-2 weeks. Follow-up evaluation was done with MRI after 3 months and DSA after 6 months, besides physical examination. Results Fifteen from 26 cases achieved immediate angiographic cure results： 14 in 20 cases which embolized with ONYX-18; only 1 in 6 cases with Glubran-2. Three in 10 cases of thoracic SDAVF and 12 in 16 cases of lumbar/sacral SDAVF were cured with embolization. Partially embolized cases were treated with surgical obliteration of drainage veins within 2 weeks. Cured patients experienced immediate improvement after embolization and kept getting better in the follow-up. All the patients had MRI follow-up after 3 months and DSA follow-up after 6 months. In 6 month＇s follow-up,MRI showed the edema and flow void signal in the spinal cord disappeared. DSA showed no fistula recurrence or remnant. There was no deterioration case in all of

关 键 词：脊髓血管疾病 中枢神经系统血管畸形 动静脉瘘 介入栓塞 治疗性 

分 类 号：R651.2[医药卫生—外科学]