近端血管阻断技术在经静脉入路栓塞颅内动静脉畸形中的应用  

Application of the pressure cooker technique in transvenous embolization of intracranial arteriovenous malformations

作　　者：徐善才[1] 孙博文[1] 吴培[1] 张广[1] 季智勇[1] 王春雷[1] 史怀璋[1] Xu Shancai;Sun Bowen;Wu Pei;Zhang Guang;Ji Zhiyong;Wang Chunlei;Shi Huaizhang(Department of Neurosurgery,the First Afiliated Hospital of Harbin Medical University,Harbin 150001,China)

机构地区：[1]哈尔滨医科大学附属第一医院神经外科,哈尔滨150001

出　　处：《中华神经外科杂志》2022年第4期353-357,共5页Chinese Journal of Neurosurgery

摘　　要：目的初步探讨近端血管阻断技术在经静脉入路栓塞颅内动静脉畸形(AVM)中的应用。方法回顾性分析2016年3月至2021年3月哈尔滨医科大学附属第一医院神经外科采用近端血管阻断技术经静脉入路栓塞治疗的4例颅内AVM患者的临床资料。术后7d内复查头颅CT或MRI,判断出血或缺血性并发症情况。术后1、3、6、12个月行门诊随访,并应用改良Rankin量表评分(mRS)评估患者的预后情况,其中0~2分为预后良好,>2分为预后不良。结果4例患者均手术成功,术后即刻数字减影血管造影(DSA)显示3例完全治愈,另1例AVM的栓塞面积≥90%。术后1例患者因脑室出血发生脑疝死亡,其余3例术后均无并发症。3例患者均获得随访,随访时间[M(范围)]为13个月(8~16个月)。至末次随访,3例患者均预后良好,其中2例患者mRS为1分,另1例为0分。结论初步发现应用近端血管阻断技术经静脉入路栓塞颅内AVM的疗效较好,术后并发症较少,但仍需进一步研究确认。Objective To explore the application of pressure cooker technique(PCT)in transvenous embolization of intracranial arteriovenous malformations(AVM).Methods The clinical data of 4 patients with intracranial AVM who underwent transvenous embolization by PCT in the Department of Neurosurgery of the First Affliated Hospital of Harbin Medical University from March 2016 to March 2021 were retrospectively analyzed.Cranial CT or MRI was reviewed within 7 days after operation to determine the bleeding or ischemic complications.Outpatient fllow-up was performed at 1,3,6,and 12 months after operation,and the outcome of the patients was evaluated by the modified Rankin scale(mRS),in which 0-2 indicated good outcome,and>2 indicated poor outcome.Results All 4 patients underwent successful operations.Immediate postoperative DSA showed that 3 patients were completely cured,and the other 1 patient had an embolization area of≥90% AVM.One patient died of cerebral herniation due to intraventricular hemorrhage after operation,and the remaining 3 patients had no postoperative complications.Three patients were followed up,and the follow-up time[M(range)]was 13(8-16)months.At the last follow-up,all 3 patients had good outcomes.The mRS score of 1 was reported in 2 patients and that of 0 was reported in 1.Conclusion Preliminary findings show that PCT is effective in embolizing intracranial AVM via transvenous approach,with fewer postoperative complications,but further research and verification are needed.

关 键 词：颅内动静脉畸形 血管内操作 近端血管阻断技术 静脉入路 治疗结果 

分 类 号：R651.12[医药卫生—外科学]