儿童期脑动静脉畸形出血早期诊断和显微外科治疗  

Early diagnosis and microsurgical treatment of cerebral arteriovenous malformation hemorrhage in childhood

作　　者：文远超[1] 余云湖[1] 冉启山[1] 朱涛[2] 张川[2] 杨开华[1] 王飞[1] 

机构地区：[1]贵州省遵义市第一人民医院神经外科,563002 [2]天津医科大学总医院神经外科,天津300052

出　　处：《重庆医学》2014年第18期2282-2284,共3页Chongqing medicine

摘　　要：目的：探讨儿童期脑动静脉畸形（AVM）破裂出血急性期的确诊方式、显微外科治疗时机与急性期手术治疗效果。方法对2003～2013年收治的72例儿童（≤16岁）AVM出血患者临床资料进行回顾性分析。结果 CT确诊率为48．6％（35/72），MRI确诊率78．3％（47/60）。对条件允许的56例患者行早期全脑脑血管造影（DSA）检查，确诊率为98．2％（55/56）。72例患者均在出血急性期行显微镜下血肿清除及针对性病灶切除术，70例患者术后围术期复查 DSA/CT血管造影（CTA）/磁共振血管造影（MRA），病灶切除率为91．4％，部分切除率为8．6％。围术期死亡2例，70例存活患者中60例（85．7％）患者获得随访6个月至6年，按照 GOS评定：5分55例，4分2例，3 分2例，2分1例。结论 DSA是儿童 AVM出血早期诊断主要的检查手段；急性期显微手术可降低出血病死率和改善预后。Objective To investigate the diagnostic method,microsurgical operation time and effect of brain arteriovenous mal-formation（AVM）rupture hemorrhage in childhood.Methods 72 children （≤16 years old）of AVM hemorrhage from 2003 to 2013 were retrospectively analyzed.Results The CT diagnosis rate was 48.6%（35/72）,the MRI diagnosis rate was 78.3%（47/60）,56 cases were performed the early whole brain DSA under the condition permitting,its diagnosis rate was 98.2%（55/56）.All the cases were performed the hematoma clearance plus the pertinent lesion resection.70 cases were re-examined by DSA/CTA/MRA during postoperative perioperation period.The lesion resection rate was 91.5%,the partial resection rate was 8.6%.60 cases（85.7%） were successfully followed up for 6 months to 6 years and assessed by the Glasgow outcome scale,5 points in 5 5 cases,4 points in 2 cases,3 points in 2 cases and 2 points in 1 cases.Conclusion DSA is the main detection measure for early diagnosing AVM hem-orrhage and the microsurgical operation in the acute stage can reduce the fatality and improve the prognosis.

关 键 词：颅动静脉畸形 出血 显微外科 儿童期 

分 类 号：R726.5[医药卫生—儿科]