术前超选择栓塞富血运脑膜瘤的临床疗效分析  

Clinical efficacy of preoperative super selective embolization of blood-rich meningioma

作　　者：李捷 龙霄翱 莫伟 梁远生 尹延庆 黄拔齐 Li Jie;Long Xi-aoao;Mo Wei(Department of Neurosurgery,Afiliated Hospital of Guangdong Medical University,Zhanjiang Guangdong 524001)

机构地区：[1]广东省湛江市广东医科大学附属医院神经外科,524001

出　　处：《卒中与神经疾病》2018年第5期567-571,共5页Stroke and Nervous Diseases

基　　金：2016年湛江市非资助科技攻关项目

摘　　要：目的探讨在术前对富血运脑膜瘤进行介入经动脉超选择栓塞的安全性、疗效及应用价值。方法回顾性分析在本院治疗的34例脑膜瘤患者,术前均经全脑血管造影(DSA)证实为富血运脑膜瘤,其中12例使用明胶海绵栓塞,15例使用PVA颗粒栓塞,7例未经栓塞直接手术,栓塞3～5d后进行开颅手术切除肿瘤,记录患者的栓塞程度、开颅切除肿瘤的出血量及肿瘤切除程度。结果栓塞术后明胶海绵组肿瘤染色完全消失3例,大部分消失9例;PVA颗粒组肿瘤染色完全消失9例,大部分消失6例;2组比较有明显差异(P<0.05);2组无与介入栓塞相关的严重并发症发生。PVA组出血量为(350±135)mL,明胶海绵组出血量为(475±265)mL,未栓塞组出血量为(660±350)mL,3组间两两比较均有明显差异(P<0.05)。PVA组肿瘤全切14例,次全切除1例;明胶海绵组全切11例,次全切除1例;未栓塞组全切7例,次全切0例。结论富血运脑膜瘤在术前进行介入栓塞能减少术中出血,降低全切难度,但并未能明显提高全切率,对于栓塞材料而言,PVA颗粒的栓塞效果比明胶海绵颗粒更好,两者均可作为富血运脑膜瘤切除术前栓塞的材料使用,术前的介入栓塞能作为富血运脑膜瘤的一项可行的辅助措施。Objective To investigate the safety,curative effect and application value of transarterial super selective interventional embolization for blood-rich meningioma before operation.Methods A retrospective analysis in 34 cases of meningioma patients was carried out.All the patients were checked by brain angiography（DSA）and confirmed as blood-rich meningioma before operation.7 cases in them were operated directly without embolization.12 cases were treated with gelatin sponge,15 cases with PVA particle embolizaiton.3～5 days after embolization the craniotomy for resection of the tumor were carried out.The degree of embolism,the amount of bleeding and the degree of tumor resection were recorded.Results After embolization,in the gelatin sponge group the tumor staining disappeared completely in3 cases and most of them disappeared in 9 cases.In the PVA particle group the tumor staining disappeared completely in 9 cases and most of them disappeared in 6 cases.The difference between the two groups was statistically significant（P〈0.05）.And there was no serious complication associated with interventional embolization in the two groups.The bleeding volume in the PVA particle group was（350±135）mL,the bleeding volume in the gelatin sponge group was（475±265）mL,and the bleeding volume in non embolized group was（660±350）mL.The differences among the three groups were statistically significant.In the PVA particle group,there were 14 cases of total tumor resection and 1 case of subtotal resection.In the gelatin sponge group,there were 11 cases of total tumor resection and 1 case of subtotal resection.In the non embolism group,there were 7 cases of total tumor resection and 0 case of subtotal resection.Conclusion The preoperative interventional emobolization of blood-rich meningioma could reduce the operative bleeding before operation and the difficulty of total resection.But the total resection rate did not increase obviously.For embolic materials,the embolization effect of PVA particles was better than that o

关 键 词：富血运脑膜瘤 脑血管造影 经动脉栓塞 

分 类 号：R739.41[医药卫生—肿瘤]