早期显微手术切除低级别出血性脑动静脉畸形31例报道  

Early microsurgical removal of 31 patients with low-grade （Spetzler-Martin I-II） bleeding arteriovenous malformations

作　　者：仰鹏志[1] 赵兵[1] 江涛[1] 沈杰[1] 谭捷[2] 

机构地区：[1]安徽医科大学第二附属医院神经外科,合肥230601 [2]安徽医科大学第二附属医院超声诊断科,合肥230601

出　　处：《中华神经医学杂志》2017年第6期625-629,共5页Chinese Journal of Neuromedicine

摘　　要：目的探讨早期显微手术切除低级别出血性脑动静脉畸形（AVM）的安全性和有效性。方法回顾性分析安徽医科大学第二附属医院神经外科2009年10月至2015年12月行早期显微手术治疗的31例出血性脑AVM患者的临床资料（出血1周内）。所有患者人院时经头颅CT血管造影或全脑DSA检查确诊，其中18例患者术中使用超声辅助。术后使用GOS评分评估神经功能，根据其评分分为预后良好组（4～5分）和预后不良组（〈4分），比较2组患者术前临床资料的差异。术后行全脑DSA或头颅CTA复查，根据术后脑AVM有无残留分成残留组和未残留组，比较2组患者临床资料及术中使用超声的差异。结果31例患者中术后27例预后良好（87．1％）。与预后不良组比较，预后良好组中GCS评分〉8分及年轻患者的的比例明显增高，差异有统计学意义（P〈0．05）。31例患者中5例患者术后有脑AVM残留（总残留率16．1％）。残留组中Spetzler-Martin分级（SMG）I级患者的比例明显低于未残留组，差异有统计学意义（P〈0．05）。2组中使用术中超声辅助的比例比较，差异无统计学意义（P〉0．05）。结论在超声辅助下早期显微手术治疗低级别出血性脑AvM是安全有效的，能够快速降低颅内压，预防再出血，从而缩短住院日，促进患者更加快速及时的康复。年轻及GCS评分〉8分的患者预后可能较好，SMGI级患者手术全切率相对更高。Objective To explore the safety and effectiveness of early microsurgical removal of low-grade （Spetzler-Martin I-II） bleeding arteriovenous malformations. Methods The clinical data of 31 patients with low-grade AVM by microsurgical treatment in our hospital from October 2009 to December 2015 were retrospectively reviewed in the acute stage of bleeding （within the first week after bleed）. All patients showed a cerebral AVM on DSA or CTA at admission, 18 of whom underwent intraoperative ultrasound. Neurological outcomes were assessed with Glasgow outcome scale （GOS） after operation. According to the GOS scores, the patients were divided into good prognosis group （scores of 4-5） and poor prognosis group （scores of〈4）; the differences of preoperative clinical data between the two groups were compared. After operation, cerebral DSA or CTA was performed. According to the postoperative brain AVM with or without residual, the patients were divided into residual group and no-residue group; the differences of the clinical data and use of ultrasound in operation were analyzed statistically between the two groups. Results A favorable functional outcome was observed in 27 patients （87.1%）; as compared with that in the poor prognosis group, the proportion of Glasgow coma scale （GCS） scores〉8 and young patients in the good prognosis group was significantly higher （P〈0.05）. In 31 patients, there were 5 with residual brain AVM （total residual rate 16.1%）; the proportion ofpatients with Spetzler-Martin grading （SMG） I in the residual group was significantly lower than that in the no-residue group （P〈0.05）. There was no statistically significant difference in the proportion of intraoperative ultrasound use between the two groups （P〉0.05）. Conclusions Early microsurgery for grade I-II bleeding AVMs is a safe and definitive treatment with intraoperative ultrasound, achieving both immediate cerebral decompression and protection against rebreeding, reducing hospital stays and al

关 键 词：脑动静脉畸形 显微外科技术 术中超声 

分 类 号：R651.12[医药卫生—外科学]