脑膜中动脉栓塞治疗急性外伤性硬脑膜外血肿的疗效分析  

Middle meningeal artery embolization in treating acute traumatic epidural hematoma: an analysis of efficacy

作　　者：仇成傑 左乔[1] 张煜辉 于瀛[1] 李翯[1] 方亦斌[1] 李强[1] 赵瑞[1] 王来兴[1] 杨鹏飞[1] 刘建民[1] QIU Cheng-jie;ZUO Qiao;ZHANG Yu-hui;YU Ying;LI He;FANG Yi-bin;LI Qiang;ZHAO Rui;WANG Lai-xing;YANG Peng-fei;LIU Jian-min(Stroke Center,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Spinal Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200120,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院脑血管病中心,上海200433 [2]上海交通大学医学院附属仁济医院脊柱外科,上海200120

出　　处：《第二军医大学学报》2021年第2期153-156,共4页Academic Journal of Second Military Medical University

摘　　要：目的观察脑膜中动脉(MMA)栓塞治疗急性外伤性硬脑膜外血肿(ATEDH)的有效性和安全性。方法回顾性分析2010年1月至2020年1月在海军军医大学(第二军医大学)长海医院脑血管病中心接受MMA栓塞治疗的40例ATEDH患者资料。患者于发病24 h内行局部麻醉下数字减影血管造影(DSA)+MMA栓塞术,介入栓塞术后根据患者意识状态、血肿体积予药物保守治疗、钻孔引流术或开颅血肿清除术。随访至术后6个月,观察患者术后病情、血肿吸收情况及并发症发生情况。结果40例ATEDH患者中男21例、女19例,年龄为16~68岁,入院时格拉斯哥昏迷量表(GCS)评分为13~15分者25例,9~12分者15例。40例患者脑血管造影均显示MMA为出血源,均在介入栓塞术后出血立即停止。8例患者采用单纯MMA栓塞治疗,32例MMA栓塞后行钻孔引流术,无患者因病情进展接受开颅血肿清除术。出院时40例ATEDH患者的GCS评分均为15分,头痛、恶心、呕吐等临床症状与入院时相比均明显好转。术后6个月复查时,40例患者均未见血肿进展或复发,扩展的格拉斯哥结局量表评分均为8分。随访过程中,所有患者均未发生手术相关的感染、缺血性脑卒中、神经功能障碍等并发症。结论MMA栓塞可以有效控制ATEDH进展,减少再出血风险,能有效避免患者进一步接受创伤较大的外科侵入性干预。Objective To evaluate the efficacy and safety of middle meningeal artery(MMA)embolization in the treatment of acute traumatic epidural hematoma(ATEDH).Methods The data of 40 patients with ATEDH,who received MMA embolization from Jan.2010 to Jan.2020 in the Stroke Center of Changhai Hospital of Naval Medical University(Second Military Medical University),were retrospectively analyzed.The patients underwent digital subtraction angiography(DSA)+MMA embolization under local anesthesia within 24 h of onset.After the embolization,drug treatment,burr-hole drainage or hematoma evacuation by craniotomy were given according to the consciousness and the hematoma volume.The patients were followed up for 6 months to observe postoperative disease condition,absorption of hematoma and complications.Results There were 21 males and 19 females in the 40 ATEDH patients(aged from 16 to 68 years).The Glasgow coma scale(GCS)score on admission ranged from 13 to 15 in 25 patients and from 9 to 12 in 15 patients.Cerebral angiography showed that MMA was the bleeding artery in the 40 patients,and the bleeding stopped immediately after MMA embolization.Eight patients were treated with simple MMA embolization,32 patients were treated with burr-hole drainage after MMA embolization,and no patients received craniotomy.At discharge,the GCS scores of all the 40 ATEDH patients were 15,and the clinical symptoms such as headache,nausea and vomiting were improved compared with those at admission.Six months after operation,no hematoma developed or recurred,and the score of Glasgow outcome scale-extended was 8 in all the patients.During the follow-up,no operation-related complications such as infection,ischemic stroke or neurological dysfunction were noticed.Conclusion MMA embolization can effectively control the progress of ATEDH,reduce the risk of rebleeding,and prevent patients from undergoing further surgical invasive intervention.

关 键 词：创伤 颅内硬脑膜外血肿 脑膜中动脉 血管内治疗 治疗性栓塞 脑血管造影术 

分 类 号：R651.154[医药卫生—外科学]