显微外科手术与血管内介入栓塞治疗颅内动-静脉畸形疗效分析  

Curative effect analysis of intracranial arteriovenous malformation treated by microsurgery or endovascular interventional embolization

作　　者：程林[1] 薛哲[1] 马玉栋[1] 孔东生 王文鑫[1] 武琛[1] 孙正辉[1] CHENG Lin;XUE Zhe;MA Yu-dong;KONG Dong-sheng;WANG Wen-xin;WU Chen;SUN Zheng-hui(Department of Neurosurgery, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院神经外科,北京100853

出　　处：《中国现代神经疾病杂志》2017年第12期898-904,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：北京市科技计划课题(项目编号:Z141107002514052)~~

摘　　要：目的探讨显微外科手术与血管内介入栓塞两种治疗方法在颅内动-静脉畸形治疗中的有效性和安全性。方法共53例颅内动-静脉畸形患者分别接受显微外科手术治疗(27例)和血管内介入栓塞治疗(26例),术后复查DSA确认畸形血管团切除和栓塞情况,记录手术相关并发症,术后1个月采用Glasgow预后分级(GOS)评价临床预后。结果27例行显微外科手术治疗的患者中26例畸形血管团消失,治愈率达96.30%(26/27);术后遗留肢体运动障碍2例(7.41%)、神经功能障碍1例(3.70%)、癫持续状态1例(3.70%),手术相关并发症发生率为14.81%(4/27);术后1个月GOS评分5分15例(55.56%)、4分10例(37.03%)、3分2例(7.41%),预后良好率为92.59%(25/27)。26例行血管内介入栓塞治疗的患者中8例首次栓塞后畸形血管团消失,治愈率为30.77%(8/26);术后遗留肢体运动障碍2例(7.69%)、神经功能障碍2例(7.69%),手术相关并发症发生率15.38%(4/26);术后1个月GOS评分5分17例(65.38%)、4分7例(26.92%)、3分2例(7.69%),预后良好率为92.31%(24/26)。结论显微外科手术是颅内动-静脉畸形安全、有效的治疗方法;对于Puerto Rico评分≤3分的患者,血管内介入栓塞治疗可以获得较好疗效;对于复杂颅内动-静脉畸形,采取多次、分期介入栓塞或介入栓塞+放射治疗可以有效缓解症状、改善预后。Objective To explore the efficacy and safety of microsurgery and endovascular interventional embolization for treating intracrania] arteriovenous malformation （AVM）. Methods A total of 53 AVM patients underwent microsurgery （N = 27） and endovascular interventional embolization （N = 26）. Postoperative DSA revealed the resection of malformed vessels and embolization. Surgery-related complications were recorded, and Glasgow Outcome Scale （GOS） was used to evaluate the prognosis one month after operation. Results In microsurgery group, postoperative re-examination revealed complete resection in 26 out of 27 cases, with the cure rate of 96.30% （26/27）. After operation, limb movement disorder occurred in 2 cases （7.41%）, neurological dysfunction occurred in one case （3.70%） and status epilepticus （SE） occurred in one case （3.70%）. The occurrence rate of postoperative complications was 14.81% （4/27）. One month after operation, GOS showed 5 score in 15 cases （55.56%）, 4 score in 10 cases （37.03%） and 3 score in 2 cases （7.41%）. The rate of good prognosis was 92.59% （25/27）. In endovascular interventional embolization group, postoperative re-examination revealed complete embolization in 8 out of 26 cases, with the cure rate of 30.77% （8/26）. After operation, limb movement disorder occurred in 2 cases （7.69%） and neurological dysfunction occurred in 2 cases （7.69%）. The occurrence rate of postoperative complications was 15.38% （4/26）. One month after operation, GOS showed 5 score in 17 cases （65.38%）, 4 in 7 eases （26.92%） and 3 in 2 cases （7.69%）. The rate of good prognosis was 92.31% （24/26）.Conclusions Microsurgery is a safe and effective treatment for intracranial AVM. Endovascular interventional embolization can also achieve good curative effect for patients with intracranial AVM under Puerto Rico scale ≤ 3 score. Multiple and staged embolization or embolization combined with radiotherapy can effectively reJieve symptoms and impr

关 键 词：颅内动静脉畸形 显微外科手术 栓塞 治疗性 血管造影术 数字减影 

分 类 号：R651.12[医药卫生—外科学]