PVA颗粒栓塞对慢性硬膜下血肿的疗效及MMA管径对患者预后的影响  

Effect of PVA granule embolization on chronic subdural hematoma and the influence of MMA diameter on the prognosis of patients

作　　者：闫文涛 贺秀华 胡国超 陈奎 王福超 许柯炎 王冠军[1] YAN Wen-tao;HE Xiu-hua;HU Guo-chao;CHEN Kui;WANG Fu-chao;XU Ke-yan;WANG Guan-jun(Department of Brain Disease,Xuchang Central Hospital Affiliated to Henan University of Science and Technology,Xuchang 461700,Henan,China;Department of Cardiovascular,Xuchang Central Hospital Affiliated to Henan University of Science and Technology,Xuchang 461700,Henan,China)

机构地区：[1]河南科技大学附属许昌市中心医院脑病科,河南许昌461700 [2]河南科技大学附属许昌市中心医院心血管内科,河南许昌461700

出　　处：《川北医学院学报》2024年第8期1072-1075,1084,共5页Journal of North Sichuan Medical College

基　　金：河南省医学科技攻关计划项目(LHGJ20200978);河南省许昌市科学技术局项目(20230213078)。

摘　　要：目的:探究聚乙烯醇(PVA)颗粒栓塞对慢性硬膜下血肿(CSDH)的疗效,并评估脑膜中动脉(MMA)管径对患者预后的影响。方法:将行传统方法(保守药物治疗和外科钻孔引流术)治疗的慢性硬膜下血肿患者纳入对照组(n=31);将行PVA颗粒栓塞(单纯PVA颗粒栓塞或联合外科钻孔引流术)治疗的慢性硬膜下血肿患者纳入观察组(n=31)。收集并比较两组患者疗效指标及预后指标。结果:观察组31例患者45侧血肿,19例行单纯PVA颗粒栓塞,12例行PVA颗粒栓塞联合外科手术治疗;对照组31例患者47侧血肿,15例行单纯药物治疗,16例行药物联合外科手术治疗。观察组CT血肿量减少治疗总有效率为97.78%,高于对照组的82.98%(P<0.05)。两组3个月血肿完全吸收病灶率、复发率和挽救性二次手术率均无统计学差异(P>0.05)。观察组中出现1例假性动脉瘤,两组均未发生严重并发症。治疗后3个月,观察组改良Rankin评分(mRS)与对照组比较,差异无统计学意义(P>0.05)。CSDH患者血肿侧MMA管径大于非血肿侧;复发患者MMA管径大于未复发患者,差异均有统计学意义(P<0.05)。结论:PVA颗粒栓塞治疗在CSDH中表现出较好的效果,且MMA管径对于患者预后判断具有重要作用。Objective:To investigate the efficacy of polyvinyl alcohol(PVA)particle embolization in the treatment of chronic subdural hematoma(CSDH)and to evaluate the influence of middle meningeal artery(MMA)diameter on prognosis.Methods:31 patients with chronic subdural hematoma treated with traditional methods(conservative drug therapy and surgical trepanation and drainage)were included(control group),and 31 patients with chronic subdural hematoma treated with PVA particle embolization(PVA particle embolization alone or combined with surgical trepanation and drainage)were included(observation group).The therapeutic effect indexes and prognostic indexes of the two groups were collected and compared.Results:In the observation group of 31 patients with 45 side hematoma,19 patients were treated with PVA granule embolization alone,12 patients were treated with PVA granule embolization combined with surgery.In the control group,31 patients with 47 hematomas were treated with drugs alone in 15 cases and with drugs combined with surgery in 16 cases.The total effective rate of CT hematoma reduction in the observation group was higher than that in the control group,and the difference was statistically significant(97.78%vs.87.98%,P<0.05).There was no significant difference between the observation group and the control group in the rate of complete absorption,recurrence and salvage secondary operation at 3 months(P>0.05).1 case of pseudoaneurysm occurred in the observation group,and no serious complication occurred in both groups.At 3 months after treatment,there was no significant difference in modified Rankin Scale(mRS)between the observation group and the control group(P>0.05).The MMA tube diameter on the hematoma side of CSDH patients was larger than that on the non-hematoma side,and the MMA tube diameter in patients with recurrence was larger than that in patients without recurrence,with statistical significance(P<0.05).Conclusion:PVA granule embolization showed a good effect in CSDH,and MMA tube diameter played an important rol

关 键 词：聚乙烯醇颗粒栓塞 慢性硬膜下血肿 脑膜中动脉管径 疗效 预后 

分 类 号：R651.1[医药卫生—外科学]