脑动静脉畸形手术,栓塞及栓塞加手术治疗的临床研究  

A clinical study of cerebral arteriovenous malformation treatment: Surgery, embolization and embolization plusing surgery

作　　者：苏平[1] 孙敏[1] 高鸿[1] 谷震[1] 惠金明[1] 张明[1] 彭远[1] 马刚[1] 刘俊[1] 

机构地区：[1]昆明市第一人民医院神经外科,昆明650011

出　　处：《中国微侵袭神经外科杂志》2000年第1期21-24,共4页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：云南省卫生厅科研基金!98019

摘　　要：目的通过对83例脑动静脉畸形（AVM）分别进行直接手术，单纯栓塞或栓塞加手术治疗的比较研究，探讨治疗AVM的理想有效方案。方法（1）直接手术24例，病人按Spetzler－Martn分级（S－M）Ⅰ级10例，Ⅱ级8例，Ⅲ级5例，Ⅳ级1例，Ⅲ级以上6例占25％。急诊手术10例，显微手术14例。（2）36例行单纯超选择微导管栓塞（NBCA或真丝线段），S－MⅡ级16例，Ⅲ级14例，Ⅳ级6例，Ⅲ级以上20例占55．5％。完全栓塞8例，大部分栓塞（栓塞范围＞80％）10例，部分栓塞（栓塞范围30％－50％）18例。（3）栓塞加显微手术23例，S－MⅡ级8例，Ⅲ级10例，Ⅳ级5例，Ⅲ级以上15例占65．2％。治疗1月和1年分别用GlasgowoutcomeScale（GOS）恢复评分进行分析比较。结果直接手术24例病灶全切，单纯栓塞组治愈率（8／36）22.2％，栓塞加手术23例病灶全切。术后1月GOS评价，良好率分别为58．3％，61．1％和82.6％；1年后良好率分别为62.5％，55．6％和91．3％。Ⅲ级以上术后并发症分别为明．3％，40％和20％。1年后单纯栓塞组复发率为44．4％，另两组无复发。结论对S－MⅢ级以上脑AVM，采用栓塞加手术可减少并发症，改善预后，优于直接手术或单纯栓塞治疗。Objective To compare the results of treatment of cerebral arteriovenous malformations (AVM) with differentmethods. Method The 83 patients were divided into three groups according to different treatment, AVM were classified onSpetzler-Martin grade scale (S-M). There were 24 cases only surgery, in which Ⅰ- Ⅱ-grade were 18 cases, Ⅲand Ⅳ-grade 6cases (25%), including emergency surgery 10 cases, microsurgery 14 cases; Superselective embolization alone were 36 cases(NBCA or silk section), Ⅰ - Ⅱ -grade 6 cases, Ⅲand Ⅳ-grade 20 cases (55.5%), complete embolization 8 cases, over 80%10 caese, less than 50% 18 cases; Embolization plusing microsurgery 23 cases, Ⅰ - Ⅱ -grade 8 cases, Ⅲand Ⅳ -grade 15cases (65.2%). Result AVMs were completely resected in 24 cases of the surgery group; Completely embolized (8/36) 22.2%in 36 cases of embolization group; Completely resected in 23 cases with embolization plusing microsurgery group. At onemonth after operation, the rates of Glasgow Outcome Scale 5 were 58.3%, 61.1% and 82.6% in three groups. At one year,they were 62.5%, 55.6% and 91.3%. The postoperative complications of Ⅲ and Ⅳ-grade were 83.3%(5/6), 40% (8/20) and 20%(3/15) respectively. At one year afer embolization, there were 16 recurrent cases(44.4%,16/36) in the embolization group, inother two groups no recurrence was found. Conclusion To Ⅲ -Ⅳ-grade AVM, the treatment of embolization plusingmicrosurgery can reduce complications and improve outcome, and it is better than that of surgery or embolization alone.

关 键 词：脑动静脉畸形 外科手术 栓塞疗法 临床研究 

分 类 号：R651.1[医药卫生—外科学]