47例幕上脑动静脉畸形破裂出血急诊术前诊断及手术治疗效果分析  

An analysis of preoperative diagnosis and treatment effects of 47 emergency operations on rupture and hemorrhage of supratentorial cerebral arteriovenous malformation

作　　者：矫永庆[1] 王迅[1] 吴文霄[1] 邹立君[1] JIAO Yong-qing;WANG Xun;WU Wen-xiao(Department of Neurosurgery,Third People’s Hospital of Dalian,Dalian 116033,China)

机构地区：[1]大连市第三人民医院神经外科,116033

出　　处：《中国现代药物应用》2022年第6期30-33,共4页Chinese Journal of Modern Drug Application

基　　金：辽宁省自然科学基金资助项目(项目编号:20180550761)。

摘　　要：目的探讨幕上脑动静脉畸形(AVM)破裂出血的急诊术前诊断及手术治疗效果。方法回顾性分析采用急诊行血肿清除及AVM显微镜下切除术治疗的47例幕上脑AVM破裂出血患者的临床资料,观察患者术中Spetzler-Martin分级、手术结果及预后。结果所有患者经病理证实为幕上脑AVM破裂出血。术中判断Spetzler-Martin分级:Ⅰ级15例,Ⅱ级13例,Ⅲ级12例,Ⅳ级3例,Ⅴ级4例。47例均急诊在显微镜下行开颅血肿清除加畸形血管切除,其中AVM全部切除35例,部分AVM切除12例。随访6个月,恢复良好19例(40.43%),轻度残疾10例(21.28%),重度残疾11例(23.40%),植物生存2例(4.26%),死亡5例(10.64%)。预后良好率为61.70%。结论对于幕上脑AVM破裂出血,充分的术前影像学评估及个体化手术策略,急诊显微镜下清除血肿的同时切除病灶是安全、有效的方法,预后较好。Objective To discuss the preoperative diagnosis and treatment effects of emergency operations on rupture and hemorrhage of supratentorial cerebral arteriovenous malformation(AVM).Methods The clinical data of 47 patients with rupture and hemorrhage of supratentorial cerebral AVM treated by emergency hematoma removal and AVM microsurgical resection were analyzed retrospectively.The intraoperative Spetzler-Martin grade,surgical results and prognosis were investigated.Results All patients were pathologically confirmed as rupture and hemorrhage of supratentorial cerebral AVM.The patients had the intraoperative Spetzler Martin grade:Grade Ⅰ in 15 cases,grade Ⅱ in 13 cases,grade Ⅲ in 12 cases,grade Ⅳ in 3 cases and grade Ⅴ in 4 cases.All 47 patients received emergency craniotomy operations under microscope for evacuation of hematoma and resection of AVM,including 35 cases of full resection of AVM and 12 cases of partial resection of AVM.After 6 months of follow-up,19 patients(40.43%)recovered well,10 patients(21.28%)had mild disability,11 patients(23.40%)had severe disability,2 patients(4.26%)were in vegetative status and 5 patients(10.64%)died.The good prognosis rate was 61.70%.Conclusion For rupture and hemorrhage of supratentorial cerebral AVM,an emergency craniotomy operation under microscope for evacuation of hematoma and excision of lesion with adequate preoperative imaging evaluation and individualized surgical strategy is safe and effective,and the prognosis is good.

关 键 词：幕上脑动静脉畸形 脑出血 急诊手术 血管造影 

分 类 号：R651.1[医药卫生—外科学]