复合手术治疗脑功能区动静脉畸形的临床研究  

Clinical Study on Combined Surgery in the Treatment of Arteriovenous Malformations in Brain Functional Areas

作　　者：Seyedali Zolfaghari 余金[1] 张庭保 赵文元 李正伟[1] 李国栋 陈劲草[1] Seyedali Zolfaghari;Yu Jin;Zhang Tingbao(Department of Neurological Surgery,Zhongnan Hospital,Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院神经外科,武汉430071

出　　处：《华中科技大学学报（医学版）》2022年第4期531-537,共7页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省技术创新专项(重大项目)资助(No.2018ACA139)。

摘　　要：目的脑动静脉畸形(arteriovenous malformation,AVM)是一种先天性脑血管发育异常疾病。本文探讨联合介入栓塞和显微手术切除的复合手术对脑功能区及附近AVM的治疗效果。方法回顾性分析了2017年7月至2022年2月在武汉大学中南医院神经外科接受“介入栓塞联合显微手术的复合手术方式”治疗的36例脑功能区AVM患者临床资料。通过分析栓塞体积、术中首次造影、显微切除次数、术中出血量、手术时间及术中并发症等术中指标展示复合手术治疗脑功能区AVM的手术特点。并通过格拉斯哥预后分级标准对患者术后近期及远期疗效进行预后评价。结果显微切除前平均栓塞体积约60%,栓塞后一次性显微完整切除19例(52.78%),畸形血管团残留少于3%者4例。显微切除轮次最多4次,最少1次。完整复合手术治疗后,仅1例患者有病灶残留。患者术中平均出血量800 mL。手术总时间平均5.5 h。术后近期预后良好率为58.33%,远期预后良好率为72.22%。结论复合手术为脑功能区AVM的一期完全切除提供了一种安全有效的治疗方式。Objective Cerebral arteriovenous malformation(AVM)is a congenital cerebrovascular dysplasia.In this paper,the therapeutic effect of combined interventional embolization and microsurgical resection on AVM in the brain functional area was discussed.Methods This study retrospectively analyzed the clinical data of 36 patients with brain functional area AVM who received interventional embolization combined with microsurgery in the Neurosurgery Department of Zhongnan Hospital Affiliated to Wuhan University from July 2017 to February 2022.The characteristics of combined surgery in the treatment of AVM in brain functional areas were demonstrated by analyzing the volume of embolization,the first intraoperative angiography,the times of microsurgery,the amount of intraoperative bleeding,the operation time and intraoperative complications.The short-term and long-term effects were evaluated by Glasgow outcome scale.Results The average preoperative embolic volume was about 60%before microsurgery,19 patients(52.78%)received total resection by microsurgery after embolization,and proportion of residual malformed vascular mass in 4 patients was less than 3%.The maximum number of microsurgery was 4 and the minimum was 1.After combined surgical treatment,only 1 patient had residual lesions.The average intraoperative blood loss was 800 mL.The average total operation time was 5.5 h.The short-term good prognosis rate was 58.33%,and the long-term good prognosis rate was 72.22%.Conclusion The combined surgery is a safe and effective treatment for primary complete resection of AVM in brain functional areas.

关 键 词：脑动静脉畸形 脑功能区 复合手术 介入栓塞 显微手术 

分 类 号：R651.121[医药卫生—外科学]