硬脊膜下脊髓血管畸形自然病史及长期临床结果的回顾性研究
发布时间：2019-03-25 12:59
【摘要】：研究目的分析硬脊膜下脊髓血管畸形的自然病史及长期临床结果。探讨目前治疗策略的有效性、安全性以及进一步提高该疾病解剖治愈率的可行性。研究方法纳入本中心取得长期随访结果的硬脊膜下脊髓血管畸形病例283例,对其病变结构,发病年龄,发病方式,发病后病情演变方式,治疗前后脊髓功能状态,治疗方式,病变闭塞比例,治疗并发症,术后远期再加重情况等临床数据进行统计分析。研究结果硬脊膜下脊髓血管畸形的发病方式包括突发起病(57%)及逐渐起病(43%)。突发起病者多可以自行缓解(63.3%),若观察时间超过2个月,Nidus-type及Fistula-type的自发缓解率分别为77.4%及82.4%。Nidus-type以及Fistulatype缓解后分别有40例(39.2%)及18例(30.0%)出现再加重,若观察时间超过1年则再加重率分别达到89.2%及62.5%。其出现逐渐再加重的高峰时间为发病5年之后,出现突发加重的高峰时间为发病后2个月内及发病5年后。逐渐起病的Nidus-type以及Fistula-type病例在治疗前症状呈现进展趋势的比例分别为100%及90.6%。Nidus-type及Fistula-type的解剖治愈率分别为27.0%及58.9%,治疗前两者的平均脊髓功能评分分别为3.9±3.4分及4.3±3.4分,随访时恢复至2.8±2.8分及2.5±2.5分。突发起病的Nidus-type及Fistulatype病例在治疗后发生再加重的比例分别降至23.5%及6.7%,逐渐起病的Nidus-type及Fistula-type病例在接受治疗后发生再加重的比例分别降至47.4%及15.6%。术后远期加重的病例均为部分治疗后的病例,其中Nidus-type部分治疗后远期加重病例32例,包括逐渐加重15例,突发加重17例,其部分治疗后年突发加重率为2.96%/年,较治疗前(5.95%/年)明显降低。Fistulatype部分治疗后远期加重病例10例,包括逐渐加重6例,突发加重4例,其部分治疗后年突发加重率为1.46%/y,较治疗前(5.76%/年)显著降低。治疗相关并发症共43例,其中Nidus-type 30例,Fistula-type 13例,在部分治疗的Nidus-type病例中并发症的发生率随着病变闭塞比例增高而升高。复合手术组的Nidus-type病例的临床特点及病变结构与非复合手术组相比较无显著差异,但解剖治愈率更高(63.6%V.S 42.2%)并且两组并发症发生率相当(27.3%V.S28.1%);复合手术组的Fistula-type病例供血动脉来源与非复合手术组相比更加复杂,但两者的解剖治愈率持平(77.8%V.S 78.2%)并且复合手术组的并发症发生率更低(11.1%V.S 19.6%)。研究结论突发起病的病例,无论是Nidus-type还是Fistula-type均不应在急性期进行外科手术干预,但应该提倡早期行介入手术闭塞出血危险结构。而对于逐渐发病的病例应提倡早期治疗。目前的治疗方法安全有效。但是对于结构相对复杂的病变在提高病变闭塞率的同时会增加并发症的风险,而部分治疗并不能将病变自身所带来的脊髓损伤风险完全去除。复合手术可以安全的提高病变的全切率。
[Abstract]:Objective to analyze the natural history and long-term clinical results of subdural spinal vascular malformation. To explore the effectiveness, safety and feasibility of improving the anatomical cure rate of the disease. Methods 283 cases of subdural spinal cord vascular malformations were included in the study. The pathological structure, age of onset, mode of onset, the way of disease evolution after onset, the state of spinal cord function before and after treatment, and the mode of treatment were analyzed. The clinical data such as occlusive ratio, treatment complications and long-term exacerbation after operation were analyzed statistically. Results the pathogenesis of subdural spinal vascular malformations included sudden onset (57%) and progressive onset (43%). Most of the patients with sudden onset can relieve themselves (63.3%). If the observation time is longer than 2 months, The spontaneous remission rates of Nidus-type and Fistula-type were 77.4% and 40 cases (39.2%) and 18 cases (30.0%) of 82.4%.Nidus-type and Fistulatype respectively. If the observation time is more than 1 year, the weight gain rate will reach 89.2% and 62.5% respectively. The peak time of gradual aggravation was 5 years after onset, and the peak time of sudden exacerbation was within 2 months after onset and 5 years after onset. The percentage of progressive symptoms in Nidus-type and Fistula-type cases before treatment was 100%, and the anatomical cure rates of 90.6%.Nidus-type and Fistula-type were 27.0% and 58.9%, respectively. The mean spinal cord function scores before treatment were 3.9 卤3.4 and 4.3 卤3.4, respectively, and recovered to 2.8 卤2.8 and 2.5 卤2.5 at follow-up. The incidence of exacerbation in Nidus-type and Fistulatype cases after treatment decreased to 23.5% and 6.7%, respectively. The rate of exacerbation of Nidus-type and Fistula-type cases after treatment decreased to 47.4% and 15.6%, respectively. The cases with long-term exacerbation after partial treatment were all cases after partial treatment, including 32 cases with long-term aggravation after partial treatment with Nidus-type, including 15 cases with progressive aggravation and 17 cases with sudden aggravation, and the rate of sudden exacerbation after partial treatment was 2.96% / year. Fistulatype had 10 cases of long-term aggravation after partial treatment, including 6 cases of progressive aggravation and 4 cases of sudden exacerbation, and the sudden weight gain rate of Fistulatype was 1.46% in the year after partial treatment, and it was significantly lower than that of pre-treatment (5.95% / year). It was significantly lower than that before treatment (5.76% / year). There were 43 cases of treatment-related complications, including 30 cases of Nidus-type and 13 cases of Fistula-type. The incidence of complications increased with the increase of occlusive rate in partial Nidus-type cases. There was no significant difference between the combined operation group and the non-complex operation group in the clinical characteristics and pathological changes of Nidus-type cases. But the anatomical cure rate was higher (63.6%V.S 42.2%) and the incidence of complications in the two groups was the same (27.3% V.S 28.1%). The source of blood supply artery in Fistula-type patients in the combined operation group was more complicated than that in the non-complex operation group. But the anatomical cure rate of the two groups was the same (77.8%V.S 78.2%) and the complication rate was lower in the combined operation group (11.1%V.S 19.6%). Conclusion Surgical intervention should not be carried out in patients with sudden onset of Nidus-type or Fistula-type in acute stage, but the risk structure of early interventional operation for occlusive bleeding should be advocated. [WT5HZ] [WT5 "HZ] conclusion [WT5BZ] Early treatment should be advocated for cases with progressive onset. The current treatment is safe and effective. However, the risk of spinal cord injury caused by the lesion itself could not be completely removed by partial treatment, but the risk of spinal cord injury caused by the lesion itself could not be completely removed in the treatment of the relatively complex lesions, which could increase the rate of occlusion and increase the risk of complications. Combined surgery can safely improve the total resection rate of the lesion.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.1
本文编号：2446999
[Abstract]:Objective to analyze the natural history and long-term clinical results of subdural spinal vascular malformation. To explore the effectiveness, safety and feasibility of improving the anatomical cure rate of the disease. Methods 283 cases of subdural spinal cord vascular malformations were included in the study. The pathological structure, age of onset, mode of onset, the way of disease evolution after onset, the state of spinal cord function before and after treatment, and the mode of treatment were analyzed. The clinical data such as occlusive ratio, treatment complications and long-term exacerbation after operation were analyzed statistically. Results the pathogenesis of subdural spinal vascular malformations included sudden onset (57%) and progressive onset (43%). Most of the patients with sudden onset can relieve themselves (63.3%). If the observation time is longer than 2 months, The spontaneous remission rates of Nidus-type and Fistula-type were 77.4% and 40 cases (39.2%) and 18 cases (30.0%) of 82.4%.Nidus-type and Fistulatype respectively. If the observation time is more than 1 year, the weight gain rate will reach 89.2% and 62.5% respectively. The peak time of gradual aggravation was 5 years after onset, and the peak time of sudden exacerbation was within 2 months after onset and 5 years after onset. The percentage of progressive symptoms in Nidus-type and Fistula-type cases before treatment was 100%, and the anatomical cure rates of 90.6%.Nidus-type and Fistula-type were 27.0% and 58.9%, respectively. The mean spinal cord function scores before treatment were 3.9 卤3.4 and 4.3 卤3.4, respectively, and recovered to 2.8 卤2.8 and 2.5 卤2.5 at follow-up. The incidence of exacerbation in Nidus-type and Fistulatype cases after treatment decreased to 23.5% and 6.7%, respectively. The rate of exacerbation of Nidus-type and Fistula-type cases after treatment decreased to 47.4% and 15.6%, respectively. The cases with long-term exacerbation after partial treatment were all cases after partial treatment, including 32 cases with long-term aggravation after partial treatment with Nidus-type, including 15 cases with progressive aggravation and 17 cases with sudden aggravation, and the rate of sudden exacerbation after partial treatment was 2.96% / year. Fistulatype had 10 cases of long-term aggravation after partial treatment, including 6 cases of progressive aggravation and 4 cases of sudden exacerbation, and the sudden weight gain rate of Fistulatype was 1.46% in the year after partial treatment, and it was significantly lower than that of pre-treatment (5.95% / year). It was significantly lower than that before treatment (5.76% / year). There were 43 cases of treatment-related complications, including 30 cases of Nidus-type and 13 cases of Fistula-type. The incidence of complications increased with the increase of occlusive rate in partial Nidus-type cases. There was no significant difference between the combined operation group and the non-complex operation group in the clinical characteristics and pathological changes of Nidus-type cases. But the anatomical cure rate was higher (63.6%V.S 42.2%) and the incidence of complications in the two groups was the same (27.3% V.S 28.1%). The source of blood supply artery in Fistula-type patients in the combined operation group was more complicated than that in the non-complex operation group. But the anatomical cure rate of the two groups was the same (77.8%V.S 78.2%) and the complication rate was lower in the combined operation group (11.1%V.S 19.6%). Conclusion Surgical intervention should not be carried out in patients with sudden onset of Nidus-type or Fistula-type in acute stage, but the risk structure of early interventional operation for occlusive bleeding should be advocated. [WT5HZ] [WT5 "HZ] conclusion [WT5BZ] Early treatment should be advocated for cases with progressive onset. The current treatment is safe and effective. However, the risk of spinal cord injury caused by the lesion itself could not be completely removed by partial treatment, but the risk of spinal cord injury caused by the lesion itself could not be completely removed in the treatment of the relatively complex lesions, which could increase the rate of occlusion and increase the risk of complications. Combined surgery can safely improve the total resection rate of the lesion.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R744.1
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