显微手术与复合手术在治疗出血性脑动静脉血管畸形中的比较

发布时间：2018-09-08 14:47

【摘要】：目的:通过回顾性临床病例分析,探究单纯显微外科手术与复合手术(介入栓塞+显微外科手术)对出血性脑动静脉血管畸形患者预后影响的差异。方法:1.资料来源与入组标准:本研究所有的病例资料均来自2014年4月~2017年2月河北医科大学第二医院东院区神经外科。入组标准:(1)患者入院时根据病史、影像学资料或腰椎穿刺证实为脑实质出血,蛛网膜下腔出血,脑室出血,硬膜下出血;(2)入院后全部经MRA或/和CTA或/和DSA及手术探查证实为脑动静脉血管畸形;凡符合上述标准即可诊断为出血性脑动静脉血管畸形,共有41例纳入本研究。2.病例分组:本研究分为复合手术组和单纯显微手术组,(1)复合手术组(15例):全麻下先行脑动静脉血管畸形(cAVM)的介入栓塞,栓塞全部供血动脉或部分主要供血动脉后,即刻行畸形血管团的显微外科手术切除。(2)单纯显微手术组(26例):即全麻下开颅显微外科手术切除cAVM。3.比较内容与统计方法:分别对两组患者的性别、年龄、畸形血管团直径、供血动脉、引流静脉、是否伴发动脉瘤、cAVM的部位、Spetzler-Martin分级、天坛分级、史玉泉分级、术前NIHSS评分、术后NIHSS评分、术中出血量、术中输血量、开颅手术时间、术后mRS评分、术后GOS评分等进行总结,应用SPSS13.0软件进行统计学分析。结果:复合手术组与显微手术组在cAVM的部位(x~2=0.655,P=0.418),是否伴发动脉瘤(x~2=0.307,P=0.580),主要供血动脉(x~2=4.178,P=0.372)Spetzler-Martin分级(x~2=3.876,P=0.409)天坛分级(x~2=3.219,P=0.224);史玉泉分级(x~2=4.912,P=0.080)方面无统计学意义。表明两组间具有可比性。复合手术组与显微手术组在术中出血量(Z=-1.297,P=0.195)、术中输血量(Z=-1.630,P=0.103)、手术时间(Z=-0.989,P=0.323)方面均无显著性差异。复合手术组与显微手术组在术后GOS评分(x~2=0.687,P=0.373),术后mRS评分(x~2=3.593,P=0.664)方面无显著性差异。结论:1复合手术在术中出血量、术中输血量、手术时间方面与显微手术相比无明显差异。2复合手术与显微手术相比在患者预后方面无明显差异。本组病例为单中心回顾性研究,病例数相对较少,可能存在病例偏差,其结论尚需多中心、前瞻性随机病例对照研究证实。
[Abstract]:Objective: to explore the effect of microsurgery and combined operation on prognosis of patients with hemorrhagic cerebral arteriovenous malformation by retrospective analysis of clinical cases. Method 1: 1. Data sources and admission criteria: the data of all the cases in this study were collected from April 2014 to February 2017 in the Eastern Hospital of the second Hospital of Hebei Medical University. Admission criteria: (1) according to the history, imaging data or lumbar puncture, the patients were confirmed as cerebral parenchyma hemorrhage, subarachnoid hemorrhage, ventricular hemorrhage, Subdural hemorrhage; (2) all of them were proved to be cerebral arteriovenous malformation by MRA or / and CTA or / and DSA after admission, and 41 cases were included in this study. The patients were divided into two groups: the combined operation group and the microsurgery group. (1) the combined operation group (15 cases): the (cAVM) of cerebral arteriovenous malformation was embolized first under general anesthesia, after embolization of all or part of the supplying arteries. Microsurgical resection of malformed blood vessels was performed immediately. (2) Microsurgery group (26 cases): craniotomy under general anesthesia: microsurgical resection of cAVM.3. Content and statistical methods: sex, age, diameter of abnormal vessel mass, blood supply artery, drainage vein, location of AVM associated with aneurysm, Temple of Heaven grade, Shi Yuquan grade, NIHSS score before operation were compared between the two groups. Postoperative NIHSS score, intraoperative blood loss, intraoperative blood transfusion, craniotomy time, postoperative mRS score and postoperative GOS score were summarized and analyzed statistically by SPSS13.0 software. Results: there was no significant difference in the location of cAVM between the combined operation group and the microsurgery group (xn20.655Pnr 0.418), whether or not the aneurysm was associated with the aneurysm (xT2O20.307), the main supplying artery (XM24.178P0. 372), the Spetzler-Martin (xO23.876P0.409), the Temple of Heaven (XJ23.219P0.224), and the Shi Yuquan (XJ24.912P0.080). It shows that the two groups are comparable. There was no significant difference between the two groups in terms of intraoperative blood loss (ZT-1. 297), intraoperative blood transfusion (ZP1. 630), and operative time (ZT- 0. 989 P0. 323). There was no significant difference in the GOS score between the combined operation group and the microsurgery group (x2 + 0.687% P0. 373), and in the postoperative mRS score (x 2 + 3.593% P0. 664). Conclusion there is no significant difference in blood loss, blood transfusion during operation and operative time between the two groups. 2. There is no significant difference in the prognosis of the patients between the complex operation and the microsurgery. The number of cases is relatively small and there may be a case deviation. The conclusion of this study needs to be confirmed by a prospective randomized case-control study.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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