复合手术治疗颅内动静脉畸形的临床应用  

Clinical application of hybrid surgery for the treatment of cerebral arteriovenous malformations

作　　者：吴红星[1] 帕尔哈提·热西提[1] 冯冠军[1] 杨小朋[1] 赵鹏[2] 刘青林[2] 李刚[2] 李新钢[2] 王东海[2] 

机构地区：[1]新疆维吾尔自治区人民医院神经外科,乌鲁木齐市830001 [2]山东大学齐鲁医院神经外科山东大学脑科学研究所

出　　处：《中华医学杂志》2017年第11期817-821,共5页National Medical Journal of China

基　　金：新疆维吾尔自治区科学技术厅科技支疆项目（201501158）;泰山学者建设工作专项经费资助（ts20110814）;山东省科技发展计划（2014GGE27251）;齐鲁医院临床实用新技术基金（201301）

摘　　要：目的探讨脑血管病复合手术治疗脑动静脉畸形（CAVM）的应用模式，评估复合手术的应用价值。方法回顾性分析山东大学齐鲁医院和新疆维吾尔自治区人民医院神经外科2011年7月至2016年7月应用一站式复合手术治疗CAVM的病例资料，采取＂造影诊断-开颅病变切除或并血肿清除-术中造影评估＂和＂造影诊断-术中栓塞-开颅病变切除或并血肿清除-术中造影评估＂的治疗模式，术中即时造影时于术野内放置定位标记（动脉瘤夹），辅助定位残余病灶，切除残余病灶后再次术中造影评估即刻治疗效果，术后常规颅脑CT随访。结果本组病例共37例，Spetzler-Martin分级Ⅰ级8例、Ⅱ级13例、Ⅲ级10例、Ⅳ级6例，其中急性期出血型CAVM28例，非急性期和未破裂CAVM9例；术中造影发现出血型CAVM残留6例，慢性期破裂出血CAVM切除不全1例，术中一期手术切除残余病灶，术中造影获得即刻影像学治愈，出血型AVM术后颅脑CT示术野血肿清除无占位效应，本组病例术中造影提示CAVM残留率18.92%（7/37），最终影像学治愈率100%。结论一站式复合手术技术治疗CAVM，术中可实时评估切除范围并指导手术实施，提高了手术的安全性与疗效；复合手术适用于急性出血型CAVM和需要进行术中栓塞Spetzler-MartinⅢ～Ⅳ级病人。ObjectiveTo investigate the application of hybrid technique for the treatment of cerebral arteriovenous malformations （CAVMs） and to assess the value of hybrid technique. MethodsThe cases of CAVMs treated in Qilu hospital and People＇s Hospital of Xinjiang Uygur Autonomous Region from July 2011 to July 2016 were analyzed retrospectively.Two modes of hybrid surgery, ＂angiographic diagnosis-craniotomy lesion resection or/and hematoma clearance-intraoperative angiography evaluation＂ and ＂angiographic diagnosis-intraoperative embolization-craniotomy lesion resection or/and hematoma clearance-intraoperative angiography evaluation＂ were applied for all the cases.We placed an aneurysm clip as marker in surgery field during real-time angiography.If CAVMs residues occurred during surgery, we re-resected the residue according to the guidance of the marker （clip） and DSA imaging. Intra-operative angiography evaluated the results of CAVMs resection one more time.Postoperatively, follow-up CT scan was performed for all the patients. ResultsOf all the cases with CAVMs, there were 8 cases of scale Ⅰ, 13 cases of scale Ⅱ, 10 cases of scale Ⅲ and 6 cases of scale Ⅳ according to Spetzler-Martin Scale.There were 28 cases of acute hemorrhagic CAVMs and 9 cases of chronic hemorrhagic CAVMs or no-hemorrhagic CAVMs.Intra-operative angiography showed CAVMs residues in 6 cases of acute hemorrhagic CAVMs and only one in chronic group.About 18.92% residual rate of CAVMs were found for the first time intra-operative assessment angiography.With the guidance of intra-operative angiography and aneurysm clip as Marker, all residues of CAVMs were resected totally.Follow up CT showed the hematomas disappeared in all the cases of acute hemorrhagic cases.The cure rate of CAVMs with hybrid surgery was 100% according to the final intra-operative assessment angiography. Conclusions（1）Hybrid surgery for the treatment of CAVMs in one session could evaluate the results of CAVMs resection and instruct the surgical pro

关 键 词：脑动静脉畸形 复合手术 术中栓塞 脑血管造影术 

分 类 号：R651.12[医药卫生—外科学]