血管内栓塞联合手术切除治疗脑动静脉畸形87例_医学论文.docVIP

血管内栓塞联合手术切除治疗脑动静脉畸形87例_医学论文 血管内栓塞联合手术切除治疗脑动静脉畸形87例_医学论文 作者：赵振伟，高国栋，秦怀洲，李永林，赵继培，陈玲 【关键词】 脑动静脉畸形 　　关键词: 脑动静脉畸形血管内栓塞手术 　　摘 要:目的 探讨血管内栓塞联合手术切除治疗脑动静脉畸形的有效性. 方法 1999-03/2001-03采用血管内栓塞联合手术切除治疗脑动静脉畸形87例.79例以自发性颅内出血起病，4例为头痛，4例表现为癫痫.根据Spetzler-Martin计分标准，Ⅰ级9例，Ⅱ级11例，Ⅲ级12例，Ⅳ级43例，Ⅴ级12例.血管内栓塞剂为NBCA，栓后显微外科手术切除. 结果 通过血管内栓塞治疗，57例达到75%以上的闭塞率，占66%.AVM病灶闭塞在50%～75%者22例，占25%，闭塞率小于50%者8例，占9%.栓后手术完全切除病灶82例，占94%，次全或大部切除5例，占6%.术后3例遗留偏瘫或失语，死亡1例，术后并发症发生率为4.6%. 结论 血管内栓塞联合手术切除是治疗脑动静脉畸形的有效方法，特别是对大型动静脉畸形，治愈率高，致残率和死亡率低. 　　Endovascular embolization combined surgery for87patients with cerebral arteriovenous malformations 　　Abstract:AIM To discuss the effect of endovascular em-bolization combined surgery for cerebral arteriovenous mal-formations（AVM）.METHODS From March1997to March2001，87patients were treated by endovascular em-bolization combined surgery.79patients presented with spontaneous intracranial hemorrhage，4with headache， 4with seizure.According to Spetzler and Martin grading scale，9patients were GradeⅠ，11as GradeⅡ，12as GradeⅢ，43as GradeⅣ，and12as GradeⅤ.Embolic agent was NBCA.Microsurgery was performed in all patients following the endovascular embolization.RESULTS After nidus en-dovascular embolizalion，obliteration rate more than75%of AVM were obtained in57patients（66%），that between50%～70%of AVM nidus were in22（25%），and that rate less than50%of AVM nidus in8（9%）.The lesion was to-tally removed in82patients（94%）by surgery after em-bolization，subtotal or incomplete removal was achieved in5（6%）.After surgery，3patients presented with hemiparaly-sis or aphasia and1patient died.Post-operative complication rate was4.6%.CONCLUSION Endovascular embolization combined surgery is a effective method for cerebral AVM with a high cure rate and a low morbidity and mortalily，es-pecially for large AVMs. 　　0 引言 　　脑动静脉畸形（arteriovenous malformations，AVM）最严重的表现是颅内出血，致残率和死亡率高［1，2］ .明确诊断后需尽早治疗.作为有效治疗手段之一的显微外科手术对于大型复杂的脑AVM而言，全切除率低，并发症多.通过血管内栓塞可闭塞AVM大部及主要供血动脉，有利于手术切除病变. 　　1 对象和方法 　　1.1 对象 　　 ①病例资料:1997-