小脑实质性血管母细胞瘤术前栓塞的疗效分析  

Preoperative embolization of solid cerebellar hemangioblastomas

作　　者：罗昱[1] 冯大勤[1] 廖兴胜[1] 张超元[1] 余良[1] 吴松[1] LUO Yu;FENG Da-qin;LIAO Xing-sheng(Department of Neurosurgery,The First Affiliated Hospital,Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院神经外科,南宁530021

出　　处：《临床神经外科杂志》2021年第4期386-389,394,共5页Journal of Clinical Neurosurgery

基　　金：广西壮族自治区卫生和计划生育委员会课题(Z20170574)。

摘　　要：目的探讨术前栓塞实质性小脑血管母细胞瘤(CHB)的临床疗效及安全性。方法对18例实质性小脑血管母细胞瘤进行术前栓塞(栓塞组),其中栓塞后行手术切除肿瘤者17例。同期未行术前栓塞而直接行手术切除肿瘤20例患者为对照组。结果栓塞组患者中,肿瘤血供完全栓塞10例、大部分栓塞5例、部分栓塞3例;1例患者栓塞术中发生蛛网膜下腔出血致脑疝死亡;1例患者术后死于肺部感染,栓塞后发生脑梗死1例;显微镜下全切肿瘤16例、大部分全切1例。栓塞组与对照组患者的肿瘤大小、手术时间、术中出血量的差异有统计学意义(P<0.05~0.01);而并发症及预后差异无统计学意义。结论术前对有潜在高出血风险的实质性小脑血管母细胞瘤进行栓塞是手术切除肿瘤的有效辅助治疗方法。但是对于高流量的小脑血管母细胞瘤术前栓塞存在一定的危险性,需具体评估栓塞的风险,选用个体化的冶疗方案。Objective To evaluate the clinical effect of preoperative embolization of solid cerebellar hemangioblastoma(CHB).Methods 18 cases of solid CHB were embolized before operation.In the same period,20 cases of solid CHB were resected without embolization(control group).Results In the embolization group,total endovascular occlusion obtained in 10 patients,near total occlusion in 5,and incomplete occlusion in 3.One patient died of cerebral hernia following subarachnoid hemorrhage during embolization and one died of lung infection after surgery and one occurred cerebral infarction after embolization.16 patients underwent gross total resection and one underwent partial resection.There were statistically significant differences between the experimental and control groups in tumor size,duration of surgery,amount of intraoperative blood loss(P<0.05).However,complications and prognosis showed no significant differences between groups.Conclusions Preoperative embolization with potentially high risk of bleeding of solid CHB is an effective adjuvant therapy for resection of tumors.However,for high-flow solid CHB,preoperative embolization is dangerous.The risk of embolism should be evaluated and individualized treatment should be used.

关 键 词：小脑实质性血管母细胞瘤 术前栓塞 并发症 预后 

分 类 号：R739.41[医药卫生—肿瘤]