介入栓塞治疗儿童Galen静脉动脉瘤样畸形预后相关因素分析  

Analysis of prognostic risk factors for aneurysmal malformation of the great vein of Galen in children treated with interventional embolization

作　　者：赵思琪 应建彬 陈炫杰 陈帆 张桃桃 赵清爽[1] 荆俊杰[1] Zhao Siqi;Ying Jianbin;Chen Xuanjie;Chen Fan;Zhang Taotao;Zhao Qingshuang;Jing Junjie(Department of Neurosurgery,Fujian Children’s Hospital,Fujian Branch of Shanghai Children’s Medical Center,College of Clinical Medicine for Obstetrics,Gynecology&Pediatrics,Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建省儿童医院、上海儿童医学中心福建医院、福建医科大学妇儿临床医学院神经外科,福州350000

出　　处：《临床小儿外科杂志》2025年第2期125-130,共6页Journal of Clinical Pediatric Surgery

基　　金：福建省省级临床重点专科建设项目-福建省儿童医院小儿神经外科[闽卫医政(2023)1163号]。

摘　　要：目的通过总结病例和文献复习,探讨影响儿童大脑大静脉动脉瘤样畸形(vein of Galen aneurysmal malformation,VGAM)介入栓塞治疗预后的风险因素。方法收集2021年9月至2023年3月福建省儿童医院神经外科采取介入治疗的VGAM患儿临床资料,同时检索2010年1月至2024年10月PubMed、MEDLINE、Embase数据库上公开发表的相关文献,收集患儿临床资料,包括年龄、性别、临床症状、病变血管结构、栓塞次数、首次栓塞途径、栓塞程度以及预后,分析预后相关因素。结果按照纳排标准共筛选出7篇文献报道67例患儿,与本院收治的3例合并纳入分析。70例患儿中,经介入栓塞治疗后预后良好46例(65.7%),预后不良24例(34.3%);男48例,女22例;首诊时间:产前14例,新生儿期23例,婴幼儿期33例;术前41例(58.6%)存在心力衰竭症状,33例(47.1%)合并脑积水;脉络丛型46例(65.7%),壁型24例(34.3%);29例经1次栓塞成功(41.4%),41例栓塞次数≥2次(58.6%);首次栓塞经动脉途径51例(72.9%),经静脉或双通路19例(27.1%);27例(38.6%)术后完全闭塞,43例未完全闭塞(61.4%)。单因素分析结果显示,闭塞程度可能是预后相关因素(P=0.046)。多因素分析结果显示,病变血管结构(P=0.013)和闭塞程度(P=0.046)均是预后相关因素,脉络膜型预后良好的概率为壁型的0.175倍,完全闭塞者预后良好的概率为未完全闭塞者的3.370倍。结论介入栓塞是治疗Galen静脉动脉瘤样畸形的首选方案,病变血管结构为壁型以及栓塞术后完全闭塞是预后良好的相关因素。Objective To summarize the relevant clinical data to identify risk factors for the prognosis of pediatric aneurysmal malformation of great vein of Galen Galen aneurysmal malformation(VGAM)children undergoing interventional embolization.Methods From September 2021 to March 2023,we recruited 3 VGAM children receiving interventional treatment at our department and screened for the relevant literature items published in the electronic databases of PubMed,MEDLINE and EMBASE from January 2010 to October 2024.The relevant clinical data included age,gender,clinical symptoms,vascular structure,number of embolization events,initial embolization route,degree of embolization occlusion and prognosis.Statistical analysis was performed for identifying the risk factors associated with prognosis.Results According to the inclusion and exclusion criteria,a total of 67 cases from 7 articles were eligible along with 3 children at our department for analysis.Among a total of 70 cases,65.7%(46/70)had a good prognosis after interventional embolization while 34.3%(24/70)a poor prognosi.The ratio of boy-to-girl was 48:22.There were prenatal cases(n=14),neonates(n=23)and infants&toddlers(n=33).The pre-existing conditions included heart failure(58.6%,41/70)and hydrocephalus(47.1%,33/70).The clinical types of pathological vascular structure were choroid plexus(65.7%,46/70)and wall(34.3%,24/70).The frequency of embolization was once(41.4%,29/70)and≥twice(58.6%,41/70).Initial embolization route was arterial(72.9%,51/70)and venous or dual(27.1%,19/70).Postoperative occlusion was complete(38.6%,27/70)and incomplete(61.4%,43/70).Univariate analysis revealed that degree of occlusion might be a predictive factor for prognosis(P=0.046).Multivariate analysis indicated that structure of diseased blood vessels(P=0.013)and degree of occlusion(P=0.046)were both related risk factors for predicting prognosis.The probability of good prognosis for choroidal type was 0.175 fold that of wall type.And the probability of good prognosis for completely occluded

关 键 词：GALEN静脉动脉瘤样畸形 血管内治疗 栓塞 治疗性 治疗结果 影响因素分析 儿童 

分 类 号：R743.4[医药卫生—神经病学与精神病学] R726.5[医药卫生—临床医学]