复合手术治疗硬脊膜动静脉瘘的疗效观察  

Observation on the efficacy of hybrid surgery in the treatment of spinal dural arteriovenous fistula

作　　者：任晋瑞[1] 贾贵军[1] 闫晓鹏[1] 李军伟[1] 甄自刚[1] 任少华[1] 吉宏明[1] Ren Jinrui;Jia Guijun;Yan Xiaopeng;Li Junwei;Zhen Zigang;Ren Shaohua;Ji Hongming(Department of Neurosurgery,Shanxi Provincial People′s Hospital,the Fifth Clinical Medical College of Shanxi Medical University,Taiyuan 030012,China)

机构地区：[1]山西省人民医院神经外科,山西医科大学附属第五临床医学院,太原030012

出　　处：《中华神经外科杂志》2024年第10期1028-1032,共5页Chinese Journal of Neurosurgery

基　　金：国家重点研发计划(2021YFC2501100)。

摘　　要：目的探讨复合手术治疗硬脊膜动静脉瘘(SDAVF)的临床疗效。方法纳入2020年5月至2023年3月山西省人民医院神经外科连续收治、采用复合手术方式治疗的SDAVF患者的临床资料进行回顾性研究,共18例。所有患者均于术中行脊髓血管造影确认供血动脉、瘘口位置及引流静脉情况;于显微镜下切断瘘口处血管。术后6个月行影像学检查,并采用脊髓功能改良Aminoff-Logue评分(mALS)评估疗效,mALS 0分为治愈,较术前评分下降≥3分为改善、下降<3分为未治愈。结果所有患者均顺利完成手术,术中血管造影显示瘘口及异常引流静脉均消失。无一例患者发生手术及造影相关并发症。术后6个月,所有患者脊髓MRI检查均未见病变残留或复发;mALS为(2.06±1.98)分,与术前的(5.56±2.62)分比较,差异有统计学意义(P<0.01)。其中治愈6例,改善11例,未治愈1例。病程<3个月的7例患者中,治愈5例,改善2例;病程为3~12个月的6例患者中,治愈1例,改善5例;病程>12个月的5例患者中,改善4例,未治愈1例。结论复合手术治疗SDAVF有助于提高病变治愈比例,降低并发症;预后与病程的关系有待于进一步研究。ObjectiveTo investigate the clinical efficacy of hybrid operating techniques in the treatment for spinal dural arteriovenous fistulas(SDAVF).MethodsA retrospective analysis was conducted on the clinical data of 18 consecutive SDAVF patients treated with hybrid operation in the Neurosurgery Department of Shanxi Provincial People′s Hospital from May 2020 to March 2023.All patients underwent spinal cord angiography during operation to confirm the source of the supply artery,the location of the fistula and the extent of drainage venous.The fistulas at the beginning of drainage venous site were resected under microscope by bipolar electrocoagulation.After 6 months post surgery,imaging examinations were performed,and the efficacy was evaluated using the Modified Aminoff-Logue Scale(mALS)score.A score of 0 in mALS was considered as cured,a decrease of≥3 points from the preoperative score was considered as improved,and a decrease of<3 points was considered as uncured.ResultsAll patients successfully underwent the surgery,and intraoperative angiography confirmed the complete disappearance of the fistula and abnormal drainage veins.None of the patients experienced any complications related to the surgery or spinal cord angiography.After 6 months,Spinal MRI examination confirmed the absence of residual or recurrent lesions in all patients;the mALS score was 2.06±1.98,which showed significant improvement compared with the preoperative score of 5.56±2.62(P<0.01).Out of all cases,6 were cured,11 showed improvement,and 1 was unhealed.Among the 7 cases with a disease course of less than 3 months,5 cases were cured and 2 cases showed improvement;among the 6 cases with a disease course of 3 to 12 months,1 case was cured and 5 cases showed improvement;among the 5 cases with a disease course of more than 12 months,4 cases showed improvement and 1 case was not cured.ConclusionsHybrid operating techniques for SDAVF can enhance the cure rate of lesions and decrease complications.Further research is needed to explore the connectio

关 键 词：脊髓血管疾病 动静脉瘘 治疗结果 复合手术 

分 类 号：R651.2[医药卫生—外科学]