血管内联合显微外科手术治疗颅内动静脉畸形的临床疗效  

Clinical efficacy of the combination of endovascular therapy and microsurgery in the treatment of intracranial arteriovenous malformations

作　　者：李伟 戴嵬 杨咏波[1] 张庆荣 那世杰[1] 刘涛[1] 陶涛 杭春华 Li Wei;Dai Wei;Yang Yongbo;Zhang Qingrong;Na Shijie;Liu Tao;Tao Tao;Hang Chunhua(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospitdl of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,210008

出　　处：《中华神经外科杂志》2021年第6期572-576,共5页Chinese Journal of Neurosurgery

摘　　要：目的观察血管内联合显微外科手术治疗颅内动静脉畸形(AVM)的临床疗效。方法回顾性分析2018年8月至2020年11月南京大学医学院附属鼓楼医院神经外科采用血管内联合显微外科手术治疗的32例颅内AVM患者的临床资料。其中9例采用同期联合手术,23例采用分期联合手术。观察患者的临床疗效和相关手术并发症。结果32例患者均全切除畸形血管团,术中出血量为(378.1±179.1)m(100-900ml)。手术相关并发症包括:肢体偏瘫6例、视野缺损2例.术野少量出血1例、脑积水1例、颅内感染8例,经积极治疗后均得以控制。术后随访3-6个月,改良Rankin量表评分(mRS)0分者26例、1分者3例、2分者2例、3分者1例,预后良好(mRS为0-1分)率为90.6%(29/32)。影像学随访无一例AVM复发。结论血管内联合显微外科手术治疗颅内AVM有助于提高AVM的全切除率,减少术中出血,降低手术相关并发症的发生率。Objective To evaluate the clinical efficacy of the combination of endovascular treatment and microsurgery in the treatment of intracranial arteriovenous malformations(AVM).Methods A retrospective analysis was conducted on the clinical data of 32 cases of intracranial AVMs undergoing combined surgery at Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School form August 2018 to November 2020.In this series,9 cases undement simultaneous combined surgery and the other 23 cases underwent staged combined surgery.Results In all 32 cases,the malformed vascular mass was completely removed,and the intraoperative blood loss was 378.1±179.1 ml(100-900 ml).Surgery-related complications included 6 cases of limb hemiplegia,2 cases of visual field defect,1 case of operative field bleeding,1 case of hydrocephalus,and 8 cases of intracranial infection,all of which were controlled after active treatment.The postoperative follow-up lasted for 3 to 6 months.The modified Rankin Scale scored 26 cases with grade 0,3 cases with grade 1,2 cases with grade 2,and 1 case with grade 3.The rate of favored outcome(grade 0 to 1)was 90.6%(29/32).There was no recurrence of AVM during the imaging follow-up.Conclusion Endovascular therapy combined with microsurgery for the treatment of intracranial AVM can help increase the total resection rate of AVMs,reduce intraoperative bleeding,and reduce surgery-Srelated complications.

关 键 词：颅内动静脉畸形 显微外科手术 血管内手术 联合手术 治疗结果 

分 类 号：R651.12[医药卫生—外科学]