本文關(guān)鍵詞： 硬腦膜動(dòng)靜脈瘺 顱內(nèi)出血 高危因素 治愈性栓塞 Onyx-18　出處：《昆明醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的：探討硬腦膜動(dòng)靜脈瘺(dural arteriovenous fistulas, DAVF)顱內(nèi)出血的相關(guān)影響因素。比較不同栓塞材料在DAVF治療中的療效,并探討Onyx治愈性栓塞治療DAVF的手術(shù)技巧,為DAVF治愈性栓塞治療積累臨床經(jīng)驗(yàn),提高DAVF的臨床治療水平和療效。 材料和方法：回顧總結(jié)昆明醫(yī)科大學(xué)第一附屬醫(yī)院醫(yī)學(xué)影像科2012年1月到2014年4月收治的21例DAVF患者。將病例分成：顱內(nèi)出血組和不出血組。收集臨床和影像學(xué)資料,提取臨床資料、血管構(gòu)筑學(xué)特征等參數(shù),對(duì)比兩組DAVF在上述參數(shù)上的差異,采用SPSS17.0統(tǒng)計(jì)軟件行顱內(nèi)出血的單因素分析和二分類(lèi)Logistic回歸分析。15例患者行血管內(nèi)治療,經(jīng)動(dòng)脈途徑栓塞治療,栓塞材料為Onyx(型號(hào)為Onyx-18)、聚乙烯醇(Professional Video Assistant,PVA);經(jīng)靜脈途徑栓塞治療的途徑為：經(jīng)股靜脈→頸內(nèi)靜脈→巖下竇→海綿竇,栓塞材料為電解可脫彈簧圈(guglielmi detachable coil, GDC)+Onyx。所有患者栓塞術(shù)后即刻造影了解瘺口封閉情況,并隨訪3個(gè)月至2年。 結(jié)果：對(duì)21例患者進(jìn)行臨床資料及影像學(xué)分析,(1)一般資料：年齡31-76歲,平均50.00±10.5歲；男性14例(66.67%),女性7例(33.33%)。(2)臨床表現(xiàn)：顱內(nèi)出血14例,不出血7例；出血組男性12例(85.71%),女性2例(14.29%),具有差異(P=0.017)。(3)血管構(gòu)筑學(xué)特征：①瘺口部位：女性患者中,瘺口位于海綿竇區(qū)4例、大靜脈竇區(qū)3例(側(cè)竇區(qū)1例、竇匯區(qū)1例、上矢狀竇區(qū)1例),男性無(wú)海綿竇區(qū),大靜脈竇區(qū)14例(側(cè)竇區(qū)3例、上矢狀竇區(qū)5例、竇匯區(qū)2例,天幕-乙狀竇區(qū)4例),具有顯著差異(P=0.006)；出血組無(wú)海綿竇區(qū)DAVF,大靜脈竇區(qū)DAVF14例,具有差異(P=0.017)。②供血?jiǎng)用}：頸外系統(tǒng)53支,頸內(nèi)系統(tǒng)9支,椎-基底系統(tǒng)13支。③Borden分型：Ⅰ型5例、Ⅱ型3例、Ⅲ型13例；出血組Borden Ⅰ型+Ⅱ型共3例,Borden Ⅲ型11例,具有差異(P=0.041)。(4)將單因素分析中的具有統(tǒng)計(jì)學(xué)意義的3項(xiàng)：男性,大靜脈竇區(qū)瘺口,Borden Ⅲ型進(jìn)行二分類(lèi)Logistic回歸分析得出男性(P=0.009),大靜脈竇區(qū)(P=0.002),BordenⅢ型(P=0.034),是DAVF患者顱內(nèi)出血的高危因素。 治療：(1)本組21例患者中,經(jīng)血管內(nèi)治療15例,Onyx單獨(dú)經(jīng)動(dòng)脈栓塞10例,GDC+OnyX經(jīng)靜脈栓塞2例；PVA術(shù)前栓塞聯(lián)合外科手術(shù)2例,PVA栓塞后再行Onyx經(jīng)動(dòng)脈栓塞1例。(2)Onyx經(jīng)動(dòng)脈一次性瘺口完全閉塞的有10例,瘺口處血流明顯減少1例,2個(gè)月后復(fù)查再次行第二次栓塞治療,瘺口閉塞完全；采用GDC+Onyx經(jīng)靜脈途徑聯(lián)合栓塞的有2例,栓塞后瘺口部分栓塞和完全栓塞各1例,入路途徑為股靜脈→頸內(nèi)靜脈→巖下竇→海綿竇。(3)本組病例中無(wú)并發(fā)癥及死亡病例。(4)治療病例在2個(gè)月至2年的隨訪中,GOS評(píng)分5分12例,4分1例,3分1例。失訪1人。 結(jié)論：(1)顱內(nèi)出血是DAVF常見(jiàn)的臨床表現(xiàn)。男性以大靜脈竇區(qū)多發(fā),顱內(nèi)出血率高；女性以海綿竇區(qū)多發(fā),顱內(nèi)出血率較低。(2)DAvF供血?jiǎng)用}復(fù)雜多樣,以頸外系統(tǒng)的腦膜中動(dòng)脈和枕動(dòng)脈多見(jiàn)。(3)Borden分型簡(jiǎn)單有效,是DAVF顱內(nèi)出血影響因素,BordenⅢ型顱內(nèi)出血率高。(4)Onyx-18栓塞DAVF安全,有效,合理使用可達(dá)治愈性栓塞。(5)Onyx-18經(jīng)動(dòng)脈途徑治療DAVF,理想栓塞部位是閉塞瘺口和引流靜脈近端。(6)動(dòng)脈途徑采用Onyx-18治療DAVF,常選頸外動(dòng)脈進(jìn)行栓塞治療。(7)對(duì)于海綿竇區(qū)多源多支供血的DAVF,經(jīng)靜脈途徑微彈簧圈聯(lián)合Onyx栓塞瘺口或閉塞靜脈竇,可達(dá)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.
緇撴灉錛氬21渚嬫?zhèn)ｈ�呰繘琛屼復(fù)搴婅祫鏂欏強(qiáng)褰卞儚瀛﹀垎鏋，

本文編號(hào)：1528447