硬脑膜动静脉瘘治愈性栓塞的临床研究

发布时间：2018-02-24 02:02

  本文关键词： 硬脑膜动静脉瘘 颅内出血 高危因素 治愈性栓塞 Onyx-18　出处：《昆明医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨硬脑膜动静脉瘘(dural arteriovenous fistulas, DAVF)颅内出血的相关影响因素。比较不同栓塞材料在DAVF治疗中的疗效,并探讨Onyx治愈性栓塞治疗DAVF的手术技巧,为DAVF治愈性栓塞治疗积累临床经验,提高DAVF的临床治疗水平和疗效。 材料和方法：回顾总结昆明医科大学第一附属医院医学影像科2012年1月到2014年4月收治的21例DAVF患者。将病例分成：颅内出血组和不出血组。收集临床和影像学资料,提取临床资料、血管构筑学特征等参数,对比两组DAVF在上述参数上的差异,采用SPSS17.0统计软件行颅内出血的单因素分析和二分类Logistic回归分析。15例患者行血管内治疗,经动脉途径栓塞治疗,栓塞材料为Onyx(型号为Onyx-18)、聚乙烯醇(Professional Video Assistant,PVA);经静脉途径栓塞治疗的途径为：经股静脉→颈内静脉→岩下窦→海绵窦,栓塞材料为电解可脱弹簧圈(guglielmi detachable coil, GDC)+Onyx。所有患者栓塞术后即刻造影了解瘘口封闭情况,并随访3个月至2年。 结果：对21例患者进行临床资料及影像学分析,(1)一般资料：年龄31-76岁,平均50.00±10.5岁；男性14例(66.67%),女性7例(33.33%)。(2)临床表现：颅内出血14例,不出血7例；出血组男性12例(85.71%),女性2例(14.29%),具有差异(P=0.017)。(3)血管构筑学特征：①瘘口部位：女性患者中,瘘口位于海绵窦区4例、大静脉窦区3例(侧窦区1例、窦汇区1例、上矢状窦区1例),男性无海绵窦区,大静脉窦区14例(侧窦区3例、上矢状窦区5例、窦汇区2例,天幕-乙状窦区4例),具有显著差异(P=0.006)；出血组无海绵窦区DAVF,大静脉窦区DAVF14例,具有差异(P=0.017)。②供血动脉：颈外系统53支,颈内系统9支,椎-基底系统13支。③Borden分型：Ⅰ型5例、Ⅱ型3例、Ⅲ型13例；出血组Borden Ⅰ型+Ⅱ型共3例,Borden Ⅲ型11例,具有差异(P=0.041)。(4)将单因素分析中的具有统计学意义的3项：男性,大静脉窦区瘘口,Borden Ⅲ型进行二分类Logistic回归分析得出男性(P=0.009),大静脉窦区(P=0.002),BordenⅢ型(P=0.034),是DAVF患者颅内出血的高危因素。 治疗：(1)本组21例患者中,经血管内治疗15例,Onyx单独经动脉栓塞10例,GDC+OnyX经静脉栓塞2例；PVA术前栓塞联合外科手术2例,PVA栓塞后再行Onyx经动脉栓塞1例。(2)Onyx经动脉一次性瘘口完全闭塞的有10例,瘘口处血流明显减少1例,2个月后复查再次行第二次栓塞治疗,瘘口闭塞完全；采用GDC+Onyx经静脉途径联合栓塞的有2例,栓塞后瘘口部分栓塞和完全栓塞各1例,入路途径为股静脉→颈内静脉→岩下窦→海绵窦。(3)本组病例中无并发症及死亡病例。(4)治疗病例在2个月至2年的随访中,GOS评分5分12例,4分1例,3分1例。失访1人。 结论：(1)颅内出血是DAVF常见的临床表现。男性以大静脉窦区多发,颅内出血率高；女性以海绵窦区多发,颅内出血率较低。(2)DAvF供血动脉复杂多样,以颈外系统的脑膜中动脉和枕动脉多见。(3)Borden分型简单有效,是DAVF颅内出血影响因素,BordenⅢ型颅内出血率高。(4)Onyx-18栓塞DAVF安全,有效,合理使用可达治愈性栓塞。(5)Onyx-18经动脉途径治疗DAVF,理想栓塞部位是闭塞瘘口和引流静脉近端。(6)动脉途径采用Onyx-18治疗DAVF,常选颈外动脉进行栓塞治疗。(7)对于海绵窦区多源多支供血的DAVF,经静脉途径微弹簧圈联合Onyx栓塞瘘口或闭塞静脉窦,可达治愈性栓塞。
[Abstract]:Objective: To investigate the dural arteriovenous fistula (dural arteriovenous, fistulas, DAVF) related factors of intracranial hemorrhage. Compare the curative effect of different embolic materials in the treatment of DAVF, and to explore the surgical techniques of Onyx embolization for the treatment of DAVF curative treatment, for accumulating clinical experience of DAVF embolization cured, DAVF increased the level of clinical treatment and curative effect.
Materials and methods: We reviewed 21 cases of DAVF patients of Department of medical imaging the First Affiliated Hospital of Kunming Medical University from January 2012 to April 2014. The patients were divided into intracranial hemorrhage group and non bleeding group. Clinical and imaging data extraction, clinical data, angioarchitecture characteristics parameters, differences between two groups of DAVF in the above parameters. By using the SPSS17.0 statistical software for intracranial hemorrhage by single factor analysis and Logistic regression analysis,.15 classification of two patients underwent endovascular treatment, transarterial embolization, embolic material for Onyx (model Onyx-18), polyvinyl alcohol (Professional Video Assistant, PVA); by way of transvenous embolization therapy: femoral vein, internal jugular vein to the inferior petrosal sinus and cavernous sinus embolization material for GDC (Guglielmi detachable coil, GDC +Onyx.) in all patients immediately after embolization angiogram The closure of fistula was solved and followed up for 3 months to 2 years.
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