低级别脑动静脉畸形显微手术切除与血管内介入栓塞治疗的疗效探讨  

Comparison of microsurgical resection and endovascular embolization for low grade cerebral arteriovenous malformations

作　　者：蔡跃豪[1] 彭晖[1] 陈秋宏 黄广俊 洪映标[1] 方耿娜[1] 蔡洁波[1] Cai Yuehao;Peng Hui;Chen Qiuhong;Huang Guangjun;Hong Yingbiao;Fang Gengna(Cai Jiebo No.3 Department of Neurosurgery,Jieyang People's Hospital,Jieyang 522000,China)

机构地区：[1]广东省揭阳市人民医院神经外三科,522000

出　　处：《国际医药卫生导报》2021年第20期3169-3172,共4页International Medicine and Health Guidance News

基　　金：揭阳市科技计划项目(YLWS030)。

摘　　要：目的探讨低级别脑动静脉畸形(AVM)的外科手术切除与血管内介入栓塞2种手术方式的疗效。方法回顾性分析2015年1月至2020年12月揭阳市人民医院神经外科收治的55例AVM患者资料,全部患者均行CT血管成像(CTA)或数字减影血管造影(DSA)检查明确AVM诊断,其Spetzler-Martin分级均为Ⅲ级及Ⅲ级以下。根据治疗手段分为开颅组(23例)和介入组(32例),开颅组男12例,女11例,年龄(35.57±19.09)岁;介入组男17例,女15例,年龄(36.68±16.47)岁。分别收集两组患者的年龄、性别、入院时Spetzler-Martin分级、入院时格拉斯哥昏迷评分法(GCS)评分。对比两者术后残留率、术后并发症(偏瘫、失语)、住院天数、术后3个月的改良Rankin评分的差异。结果开颅组患者术中能够较为完整地切除畸形病灶,残留率为13.04%(3/23),明显小于介入组40.62%(13/32),住院日为(24.47±16.03)d,大于介入组(16.03±10.44)d,差异均有统计学意义(均P<0.05)。介入组术后并发偏盲、肢体瘫痪、癫痫的发生率与开颅组比较,差异无统计学意义(P>0.05);开颅组与介入组在术后3个月的改良Rankin评分比较,差异无统计学意义(P>0.05)。结论低级别AVM治疗中,介入治疗具有创伤小、恢复快的优点,开颅手术与介入治疗2种治疗手段的远期治疗效果并无明显差异。Objective To compare the efficacies of surgical resection and endovascular embolization for low grade cerebral arteriovenous malformations(AVM).Methods The clinical data of 55 AVM patients admitted to the Department of Neurosurgery of Jieyang People's Hospital from January 2015 to December 2020 were retrospectively analyzed.All patients were examined by CT angiography(CTA)or digital subtraction angiography(DSA)to confirm the diagnosis of AVM.All patients were rated grade Ⅲ and below according to Spetzler-Martin classification.According to the surgical methods,they were divided into a craniotomy group and an interventional group.There were 23 cases in the craniotomy group,including 12 males and 11 females,with an age of(35.57±19.09)years old;there were 32 cases in the interventional group,including 17 males and 15 females,with an age of(36.68±16.47)years old.Age,gender,Spetzler-Martin classification at admission,and Glasgow Coma Scale(GCS)score at admission were collected.The postoperative residual rate,postoperative complications(hemiplegia and aphasia),length of hospital stay,and modified Rankin score 3 months after the surgery were compared.Results The deformity lesions could be excised more completely in the craniotomy group,the residual rate was significantly lower than that in the interventional group[13.04%(3/23)vs.40.62%(13/32)](P<0.05).The hospital stay in the craniotomy group was longer than that in the interventional group[(24.47±16.03)d vs.(16.03±10.44)d](P<0.05).There was no statistically significant difference in the incidence of complications(hemianopsia,limb paralysis,and epilepsy)between the two groups(P>0.05).There was no statistically significant difference in the modified Rankin score between the craniotomy group and the interventional group 3 months after surgery(P>0.05).Conclusions In the treatment of low grade AVM,interventional therapy has the advantages of small trauma and quick recovery.There is no significant difference in the long-term therapeutic effect between the two surgical m

关 键 词：脑动静脉畸形 介入 微创 栓塞 手术治疗 

分 类 号：R743.4[医药卫生—神经病学与精神病学]