颈内动脉海绵窦瘘致外展神经麻痹的影响因素分析及临床随访总结  

Risk factors analysis and follow-up of abducens nerve palsy caused by carotid cavernous fistula

作　　者：崔旭波[1] 汪求精[1] 高玉元[1] 郑涛[1] 柳亚启[1] 张炘[1] 段传志[1] 李铁林[1] 

机构地区：[1]南方医科大学珠江医院神经外科,广东神经外科研究所,广东省脑功能修复与再生重点实验室,广州510282

出　　处：《中华神经医学杂志》2013年第11期1155-1159,共5页Chinese Journal of Neuromedicine

基　　金：国家临床重点建设专科资助项目

摘　　要：目的探讨颈内动脉海绵窦瘘致外展神经麻痹的影响因素，并对其预后进行临床随访总结。方法回顾性收集南方医科大学珠江医院神经外科自2000年1月至2012年8月收治的139例颈内动脉海绵窦瘘患者的病历资料，分为外展神经麻痹组和外展神经非麻痹组，应用单因素分析及二分类多因素Logistic回归分析探讨性别、年龄、发病原因、治疗前症状持续时间、有无合并颅底骨折或颅高压、瘘口侧别、瘘口血流量、瘘口数目、有无盗血及引流静脉等因素对外展神经麻痹发生的影响，并通过门诊、电话、网络等方式对外展神经麻痹组患者的预后进行随访。结果139例颈内动脉海绵窦瘘患者中外展神经麻痹组67例，外展神经非麻痹组72例。二分类多因素Logistic回归分析显示：治疗前症状持续时间长（P=0．001，R=4．073，95％CI：1．745-9．510）、合并颅底骨折或颅高压（P=0．009，R=2．829，95％CI：1．294～6．185）、瘘口血流量大（P=0．015，R=3．336。95％CI：1．261-8．823）及经岩上、下窦引流（P=0．001，R=6．791，95％CI：2．129-21．660）是导致外展神经麻痹的4个独立影响因素。外展神经麻痹组67例患者中失访7例，外展神经完全恢复53例，未完全恢复7例；恢复时间为12～310d，平均88．9d；45例在半年内恢复，占所有恢复患者的84．9％。结论颈内动脉海绵窦瘘引起外展神经麻痹的因素是多方面的，其中经岩上、下窦引流是最主要的影响因素。外展神经麻痹平均恢复时间为3个月左右，大部分能在半年内完全恢复。Objective To explore the risk factors of abducens nerve palsy caused by carotid cavernous fistula （CCF） and follow up their prognosis. Methods One hundred and thirty-nine patients with CCF, admitted to our hospital from January 2000 to August 2012, were chosen in our study and divided into paralysis group and non-paralytic group. The relevant factors, including gender, age, etiology, duration of symptoms before treatment, accompaying by skull fracture or cerebral edema, fistula side, blood flow of fistula, number of fistula, with or without steal phenomena and venous drainage, were retrospectively analyzed with univariate analysis and multivariate binary Logistic regression analysis. And prognosis of patients with abducens nerve palsy （non-paralytic group） were followed up through the outpatient, telephone, Intemet and other means. Results In 139 patients, the number of paralysis patients was 67 and non-paralytic patients was 72. The duration of symptoms before treatment （P=0.001, R=4.073, 95%CI： 1.745-9.510）, accompaying by skull fracture or cerebral edema （P=0.009, R=2.829, 95%CI： 1.294-6.185）, blood flow of fistula （P=0.015, R= 3.336, 95%CI： 1.261-8.823） and the inferior or superior petrosal sinus drainage （P=0.001, R=6.791, 95%CI： 2.129-21.660） were the four independentrisk factors. In all, 67 paralysis patients were followed; abducens nerve completely restored in 53 and seven did not fully recover. Recovery time lasted for 12-310 d with an average of 88.9 d; 45 patients got recovery within six months, accounting for 84.9%. Conclusion Abducens nerve palsy can be caused by many factors in CCF patients, and the inferior or superior petrosal sinus drainage is the primary risk factors; after CCF being cured, most patients with abducens nerve palsy can fully restore within six months with an average of three months.

关 键 词：颈内动脉海绵窦瘘 外展神经麻痹 随访 

分 类 号：R743[医药卫生—神经病学与精神病学]