可脱球囊与覆膜支架在颈内动脉海绵窦瘘治疗中的应用

发布时间：2018-06-08 02:40

本文选题：颈内动脉海绵窦瘘 + 介入治疗　；参考：《山西医科大学》2015年硕士论文

【摘要】：目的:颈内动脉海绵窦瘘(CCF)是指颈内动脉海绵窦段或颈内动脉海绵窦段的分支破裂,与海绵窦之间形成异常的动、静脉沟通,临床上可造成波动性突眼、颅内震颤与杂音、球结膜水肿、甚至致死性鼻衄等一系列症状。目前治疗方法主要为开颅手术治疗与介入治疗,介入治疗已发展成为治疗CCF的首选手段。介入治疗采用的主要材料有可脱球囊、弹簧圈、覆膜支架等,分别适用于不同情况下的颈内动脉海绵窦瘘。国内外学者对可脱球囊治疗CCF研究较完善,覆膜支架用于介入治疗CCF的相关报道较少。分析可脱球囊与覆膜支架在CCF介入治疗中的应用,有助于临床合理选择治疗方案,明确手术指征。明确可脱球囊与覆膜支架治疗颈内动脉海绵窦漏的优缺点及预后,为临床工作选择合适治疗方案提供参考。方法:回顾性分析2010年3月-2013年12月间山西医科大学第二医院经可脱球囊治疗的颈内动脉海绵窦瘘病人9例,解放军总医院经可脱球囊治疗的颈内动脉海绵窦瘘病人8例,经覆膜支架治疗的颈内动脉海绵窦瘘病人5例,共22例CCF患者的临床病例资料。通过统计学分析,评估可脱球囊及覆膜支架治疗CCF的短期及远期预后。结果:经可脱球囊治疗的病例术程顺利,其中1例闭塞瘘口的同时栓塞了同侧颈内动脉,术后患者无特殊症状,3个月复查头颅MRI未见明显脑萎缩。其余病例复查造影见瘘口封闭,同侧颈内动脉血流通畅,术后患者颅内杂音即刻消失,术后3个月复查,1例患者患侧颈内动脉狭窄,但血流代偿良好,患者无任何症状。经覆膜支架治疗的病例支架全部置入成功,复查造影瘘口封闭,无内漏,术后3个月复查未复发,同侧颈内动脉通畅,未见狭窄。通过对临床症状改善情况的统计学分析,P0.05,两种治疗方法均有效。结论:对于颈内动脉海绵窦的病人,经可脱球囊介入栓塞治疗仍是主要手段,但随着相关技术的成熟,覆膜支架成为介入治疗颈内动脉海绵窦瘘重要的有效手段。不同栓塞材料适用于不同情况下的颈内动脉海绵窦,对于部分病例还可采用多种栓塞材料联合应用治疗。
[Abstract]:Objective: the internal carotid cavernous fistula (CCF) refers to the rupture of the cavernous sinus segment of the internal carotid artery or the internal carotid artery cavernous sinus segment, the formation of abnormal arteriovenous communication between the internal carotid artery cavernous sinus and the internal carotid artery cavernous sinus. Bulbar conjunctiva edema, even fatal epistaxis and a series of symptoms. At present, the main treatment methods are craniotomy and interventional therapy. Interventional therapy has become the first choice of treatment for CCF. The main materials used in interventional therapy are detachable balloon, coils and covered stents, which are suitable for internal carotid cavernous fistula under different conditions. Scholars at home and abroad have better research on detachable balloon therapy of CCF, and there are few reports on interventional treatment of CCF with covered stent. To analyze the application of detachable balloon and covered stent in CCF interventional therapy is helpful for clinical rational selection of treatment plan and clear indication of operation. To identify the advantages, disadvantages and prognosis of detachable balloon and covered stent in the treatment of carotid cavernous sinus leakage. Methods: from March 2010 to December 2013, 9 patients with internal carotid cavernous fistula treated by detachable balloon in the second Hospital of Shanxi Medical University and 8 patients with internal carotid cavernous fistula treated by detachable balloon in PLA General Hospital were analyzed retrospectively. The clinical data of 22 patients with CCF were analyzed. The short-and long-term prognosis of detachable balloon and covered stent for CCF was evaluated by statistical analysis. Results: the procedure of detachable balloon therapy was smooth. One case had ipsilateral internal carotid artery embolization while the fistula was occluded. There were no special symptoms in the patients after operation. No significant brain atrophy was observed on MRI 3 months after operation. In the other cases, the fistula was closed, the internal carotid artery blood flow was patency, the intracranial murmur disappeared immediately after operation, and 1 patient had the stenosis of the internal carotid artery 3 months after operation, but the blood flow compensation was good, and the patient had no symptoms. All the stents treated with covered stent were successfully implanted. The fistula was closed and no internal leakage was found. No recurrence was observed 3 months after operation. The ipsilateral internal carotid artery was patency and no stenosis was found. Through the statistical analysis of the improvement of clinical symptoms, both methods were effective. Conclusion: for patients with cavernous sinus of internal carotid artery, detachable balloon interventional embolization is still the main method, but with the maturity of related technology, covered stent has become an important and effective method for interventional treatment of cavernous fistula of internal carotid artery. Different embolization materials are suitable for internal carotid cavernous sinus under different conditions.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R651.1

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