硬脑膜动静脉瘘手术后临床转归的影响因素分析  

Postoperative outcomes of patients with dural arteriovenous fistulas:an analysis of influencing factors

作　　者：李强[1] 黄清海[1] 许奕[1] 方亦斌[1] 赵开军[1] 洪波[1] 赵文元[1] 刘建民[1] 

机构地区：[1]第二军医大学长海医院临床神经医学中心神经外科,上海200433

出　　处：《第二军医大学学报》2013年第8期874-878,共5页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81200906)~~

摘　　要：目的探讨影响硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)治疗后预后不良的危险因素。方法回顾性分析我中心近6年治疗的153例DAVF病例,收集患者临床表现、血管构筑学特征、治疗方式、影像学治疗结果和临床预后等资料,进行Kaplan-Meier估计和Cox回归分析。结果 153例患者平均随访(38.1±16.3)个月,近期随访改良Rankin评分(mRS)3～6级共21例,除术后并发症死亡的4例外,随访中死亡8例,另9例表现为神经功能缺损。Kaplan-Meier分析提示术前mRS≥3级、存在静脉窦血栓、经动静脉联合入路栓塞、术后影像学结果为部分栓塞或部分栓塞并皮质静脉引流(cortical venous reflux,CVR)、术后主窦不畅的患者有预后不良的趋势。Cox回归分析提示预后不良的危险因素包括:术前mRS≥3级(P=0.018)、术后影像学结果为部分栓塞并CVR(P=0.001)及术后主窦不畅(P=0.0001)。结论术前神经功能残损较重、术后影像学结果为部分栓塞合并CVR以及术后主窦不畅是DAVF患者治疗后预后不良的独立危险因素。Objective To investigate the prognostic arteriovenous fistulas （DAVFs）. Methods The clinical data over the past 6 years, were retrospectively analyzed. The factors for poor postoperative outcomes of patients with dural of 153 patients with DAVFs, who were treated in our institute clinical manifestations, angioarchitecture, treatment methods, neuroradiological results, and clinical outcomes were collected for Kaplan Meier estimation and Cox regression analysis. Results The patients were followed up for a mean of （38. 1±16. 3） months. Twenty-one patients showed modified Rankin scale （mRS） 3-6 during recent follow-up 4 patients died of postoperative complications, another 8 patients died during follow- up, and 9 patients presented with permanent neurologic defects. Kaplan-Meier estimation suggested that patients with poor preoperative neurologic status （mRS 3）, venous sinus thrombosis, combined arteriovenous approach embolization, partial obliteration, parital obliteration with cortical venous reflux （CVR）, and postoperative restriction of dominant venous sinuses tended to have poor clinical outcomes. Cox regression analysis demonstrated that poor preoperative neurologic status （mRS,3） （P=0. 018）, partial obliteration with CVR （P=0. 001）, and postoperative restriction of dominant venous sinuses （P= 0. 000 1） were risk factors predicting poor postoperative outcomes. Conclusion Poor preoperative neurologic status, partial obliteration with CVR, and postoperative restriction of dominant venous sinuses are the independent risk factors for poor clinical outcomes of DAVFs.

关 键 词：硬脑膜动静脉瘘 皮质静脉引流 血管内治疗 预后 危险因素 

分 类 号：R743.4[医药卫生—神经病学与精神病学]