介入栓塞联合显微手术治疗儿童脑动静脉畸形的临床研究  

Efficacies and outcomes of endovascular embolization plus microsurgery for brain arteriovenous malformations in children

作　　者：石武杰 张文博 章培良 沈志鹏[1] Shi Wujie;Zhang Wenbo;Zhang Peiliang;Shen Zhipeng(Department of Neurosurgery,Affiliated Children’s Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院神经外科,杭州310052

出　　处：《临床小儿外科杂志》2025年第2期120-124,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的分析不同手术方式治疗儿童脑动静脉畸形(cerebral arteriovenous malformation,cAVM)的差异及临床转归。方法回顾性分析2022年6月至2024年6月于浙江大学医学院附属儿童医院神经外科接受显微手术治疗和介入栓塞联合显微手术治疗的cAVM患儿临床资料,收集两种治疗方式下患儿出血量、手术时间、住院时间以及预后情况;并于患儿出院时使用改良Rankin量表(modified Rankin Scale,mRS)评估预后。结果共收治29例cAVM患儿,Spetzler-Martin分级为1~3级25例、4级4例。采取介入栓塞联合显微手术治疗10例(为介入栓塞联合手术组);单纯手术治疗19例(为单纯手术组)。单纯手术组和介入栓塞联合手术组出血量分别为(174.7±99.4)mL和(107.0±27.1)mL(t=2.780,P=0.011);显微镜下操作时间分别为[140.0(102.0,160.0)]min和[72.0(63.0,120.0)]min,Z=2.202,P=0.029;住院时间分别为[16.0(13.0,23.0)]d和[11.0(10.0,14.0)]d,Z=2.501,P=0.013;以上差异均有统计学意义(P<0.05)。与预后相关的因素为入院时mRS评分(χ^(2)=20.913,P<0.001)和cAVM的Spetzler-Martin分级(χ^(2)=8.784,P=0.032)。结论介入栓塞联合显微手术治疗儿童cAVM较单纯手术治疗住院时间和镜下操作时间更短,出血量更少。术前mRS评分和Spetzler-Martin分级与患儿预后相关。Objective Bleeding from rupture of cerebral arteriovenous malformations(cAVM)has been the most common cause of intracranial hemorrhage in children.The therapeutic goals should be preventing rebleeding and improving quality-of-life.The objective of this study was to examine the differences in surgical approaches for pediatric cAVMs.Methods From June 2022 to June 2024,retrospective analysis was performed for the relevant clinical data from 29 cAVM children undergoing endovascular embolization plus microsurgery.The relevant clinical data of blood loss volume,microscopic procedure time,hospitalization stay and outcomes were compared between two procedures.And patient outcomes were assessed by modified Rankin scale(mRS)at the time of discharge.Results The clinical grades wereⅠ-Ⅲ(n=25)andⅣ(n=4).And they were assigned to undergo interventional embolization plus microsurgery(n=10)and operation alone(n=19).Volume of blood loss was(107.0±27.1)vs.(174.7±99.4)ml and the difference was statistically significant(t=2.780,P=0.011);microscopic operative duration[72.0(63.0,120.0)vs.140.0(102.0,160.0)min],Z=2.202,P=0.029];hospitalization stay[11.0(10.0,14.0)vs.16.0(13.000,23.0),Z=2.501,P=0.013].The prognosis-related factors were admission mRS score(χ^(2)=20.913,P<0.001)and Spetzler-Martin score(χ^(2)=8.784,P=0.032).Conclusions For pediatric cAVM,endovascular embolization plus microsurgery is associated with shorter hospitalization stay,microscopic operative duration and less blood loss than surgery alone.

关 键 词：脑动静脉畸形 显微外科手术 血管内操作 栓塞 治疗结果 对比研究 

分 类 号：R726.5[医药卫生—儿科]