术前栓塞在中枢神经系统血管外皮瘤治疗中的应用  

Application of preoperative embolization in treatment of cranial and spinal hemangiopericytomas

作　　者：陈功 王明磊[2] 张荣 冷冰 朱巍 徐斌斌[2] CHEN Gong;WANG Ming-lei;ZHANG Rong;LENG Bing;ZU Wei;XU Bin-bin(Dept.of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Dept.of Neurosurgery,Shanghai Putuo District People s Hospital,Shanghai 200060,China)

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]上海市普陀区人民医院神经外科,上海200060

出　　处：《同济大学学报（医学版）》2019年第5期592-597,共6页Journal of Tongji University(Medical Science)

基　　金：国家重点研发计划“精准医学研究”重点专项(2016YFC0901003);上海市科学技术委员会医学引导类支撑项目(18411962400)

摘　　要：目的探讨术前栓塞在中枢神经系统血管外皮瘤治疗中的应用。方法回顾性分析手术切除并病理确诊的32例中枢神经系统血管外皮瘤患者,男女比率为2∶1,平均年龄(43.5±4.1)岁。部位:幕上19例(59.3%),幕下10例(31.2%),椎管内3例(9.3%)。术前DSA评估其血供、周围动静脉走形和受累情况,并根据Manelfe法进行分型。评估术前栓塞的效果、术中出血量、相关的并发症及手术全切率。结果32例中枢神经系统血管外皮瘤中,血供一般无需栓塞者6例(18.8%,6/32),血供丰富需栓塞者26例(81.3%,26/32):其中没有适合栓塞的血管构筑者5例;术前栓塞21例,栓塞总体优良率为71.4%。术前栓塞率与术中出血量呈负相关;无栓塞相关并发症;手术全切率为78.1%。病理分级:3例Ⅰ级,21例Ⅱ级,8例Ⅲ级。结论术前造影和栓塞在评估和治疗中枢神经系统血管外皮瘤是安全、有效的,可减少中枢神经系统血管外皮瘤术中出血,提高手术全切率、降低手术的并发症。Objective To evaluate the application of preoperative embolization in treatment of cranial and spinal hemangiopericytomas(HPC).Methods Clinical data of 32 patients with HPC in central nervous system treated were retrospectively analyzed.There were 19 cases located in supratentorial region(59.3%),10 cases located in infratentorial region(31.2%)and 3 cases located in spinal tube(9.3%).The blood supplies and vascular construction of tumor were evaluated with DSA and classified according to Manelfe type methods.The complications of preoperative embolization and the intraoperative blood loss were analyzed.Results Among 32 HPC patients,6 cases did not need for embolization due to less blood supplies(18.8%),21 cases(65.6%)were embolized,and embolization was not performed in 5 cases(15.6%)due to lack of suitable vascular construction.The excellent and good rate of embolization was 71.4%,which was negatively correlated with intraoperative blood loss.There were no complications related to embolization.The rate of gross total resections were 78.1%.Postoperative pathological classification showed 3 cases of gradeⅠ,21 cases of gradeⅡand 8 cases of gradeⅢ.Conclusion The preoperative embolization is safe and effective for treatment of hemangiopericytomas in central nervous system,which can shorten the operation time,diminish intraoperative blood loss,improve the rate of total resection and reduce complications.

关 键 词：脑 脊髓 血管外皮瘤 栓塞 术中出血 

分 类 号：R651.1[医药卫生—外科学]