经半—半椎板显微入路治疗硬脊膜动静脉瘘14例

发布时间：2018-06-03 19:37

本文选题：硬脊膜动静脉瘘 + 数字减影血管造影　；参考：《浙江大学》2015年硕士论文

【摘要】：目的探讨经半-半椎板显微入路手术治疗硬脊膜动静脉瘘(SDAVF)的有效性及可行性,为硬脊膜动静脉瘘的治疗提供一种新的微创方法。方法回顾分析我科2006年1月至2014年1月收治的32例硬脊膜动静脉瘘患者的临床资料。术前行MRI检查及血管造影确诊,其中男性病例27例,女性病例5例,男女比例5.4：1,平均年龄51.43岁,平均病程12.6月。其中14例患者经半-半椎板显微入路手术治疗,其余18例患者经传统全椎板入路手术治疗。两组数据进行t检验。结果硬脊膜动静脉瘘瘘口位于胸段18例,腰段12例,颈段2例。瘘口均为单动脉供血。14例患者经半-半椎板显微入路手术治疗,手术平均时间为101.86分钟,失血量平均为81.43m1,术后住院时间平均为13天,住院费用平均为24284.36元。余18例患者采用传统全椎板入路手术治疗,其中部分患者为我科开展微创手术之前患者,部分患者为不能精确定位瘘口和瘘口位于颈段。该18例患者手术平均时间为138.61分钟,失血量平均为130.56m1,术后住院时间平均为16天,住院费用平均为28098.89元。两组数据进行t检验,P0.05有统计学差异。经半-半椎板显微入路手术夹闭瘘口与传统手术方式相比较,再不增加手术并发症的前提下手术时间短、出血量少,患者住院时间及费用少。出院后随访6个月至2年,患者术后症状均较前术前好转。结论硬脊膜动静脉瘘(SDAVF)是脊髓血管畸形中最常见的一种类型,临床表现缺乏特异性,诊断首选DSA。手术治疗硬脊膜动静脉瘘是一种有效的方法。在术前行脊髓血管造影精确定位瘘口位置的前提下,且瘘口位于胸腰段时,经半-半椎板显微入路手术夹闭瘘口安全可行,且手术创伤更小,有利于脊柱稳定性的保持。
[Abstract]:Purpose To explore the effectiveness and feasibility of microsurgical treatment of dural arteriovenous fistula (SDAVF) via the semilateral laminar microapproach, and to provide a new minimally invasive method for the treatment of dural arteriovenous fistula. Method The clinical data of 32 patients with dural arteriovenous fistula from January 2006 to January 2014 were retrospectively analyzed. 27 cases were male and 5 cases were female. The ratio of male to female was 5.4: 1. The average age was 51.43 years and the average course of disease was 12.6 months. 14 of them were treated by the semilateral lamina microapproach, and the other 18 by the traditional total laminar approach. Two groups of data were tested by t test. Result Dural arteriovenous fistula was located in 18 cases of thoracic segment, 12 cases of lumbar segment and 2 cases of cervical segment. 14 patients with fistula were treated by semi-semilateral microapproach. The average operation time was 101.86 minutes, the average blood loss was 81.43m1.The average hospitalization time was 13 days, and the average hospitalization cost was 24284.36 yuan. The remaining 18 patients were treated by traditional total laminar approach, some of them were patients before minimally invasive surgery, and some patients were unable to locate the fistula orifice and the fistula orifice at the neck segment accurately. The average operative time and blood loss were 138.61 minutes, 130.56 ml, 16 days and 28098.89 yuan respectively. There was statistical difference between two groups of data by t test (P0.05). Compared with the traditional operation method, the operation time is shorter, the blood loss is less, the hospitalization time and the expense are less without increasing the complications of the operation. The patients were followed up for 6 months to 2 years after discharge. Conclusion Dural arteriovenous fistula (SDAVF) is the most common type of spinal vascular malformation. Surgical treatment of dural arteriovenous fistula is an effective method. On the premise of accurately locating the position of fistula orifice by myelography before operation and when the fistula orifice is located in thoracolumbar segment, it is safe and feasible to clip the fistula orifice through the microsurgical approach of semilateral lamina, and the surgical trauma is less, which is beneficial to the maintenance of spinal stability.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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