硬脊膜下脊髓血管畸形自然病史及長(zhǎng)期臨床結(jié)果的回顧性研究
發(fā)布時(shí)間：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長(zhǎng)期臨床結(jié)果。探討目前治療策略的有效性、安全性以及進(jìn)一步提高該疾病解剖治愈率的可行性。研究方法納入本中心取得長(zhǎng)期隨訪(fǎng)結(jié)果的硬脊膜下脊髓血管畸形病例283例,對(duì)其病變結(jié)構(gòu),發(fā)病年齡,發(fā)病方式,發(fā)病后病情演變方式,治療前后脊髓功能狀態(tài),治療方式,病變閉塞比例,治療并發(fā)癥,術(shù)后遠(yuǎn)期再加重情況等臨床數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。研究結(jié)果硬脊膜下脊髓血管畸形的發(fā)病方式包括突發(fā)起病(57%)及逐漸起病(43%)。突發(fā)起病者多可以自行緩解(63.3%),若觀察時(shí)間超過(guò)2個(gè)月,Nidus-type及Fistula-type的自發(fā)緩解率分別為77.4%及82.4%。Nidus-type以及Fistulatype緩解后分別有40例(39.2%)及18例(30.0%)出現(xiàn)再加重,若觀察時(shí)間超過(guò)1年則再加重率分別達(dá)到89.2%及62.5%。其出現(xiàn)逐漸再加重的高峰時(shí)間為發(fā)病5年之后,出現(xiàn)突發(fā)加重的高峰時(shí)間為發(fā)病后2個(gè)月內(nèi)及發(fā)病5年后。逐漸起病的Nidus-type以及Fistula-type病例在治療前癥狀呈現(xiàn)進(jìn)展趨勢(shì)的比例分別為100%及90.6%。Nidus-type及Fistula-type的解剖治愈率分別為27.0%及58.9%,治療前兩者的平均脊髓功能評(píng)分分別為3.9±3.4分及4.3±3.4分,隨訪(fǎng)時(shí)恢復(fù)至2.8±2.8分及2.5±2.5分。突發(fā)起病的Nidus-type及Fistulatype病例在治療后發(fā)生再加重的比例分別降至23.5%及6.7%,逐漸起病的Nidus-type及Fistula-type病例在接受治療后發(fā)生再加重的比例分別降至47.4%及15.6%。術(shù)后遠(yuǎn)期加重的病例均為部分治療后的病例,其中Nidus-type部分治療后遠(yuǎn)期加重病例32例,包括逐漸加重15例,突發(fā)加重17例,其部分治療后年突發(fā)加重率為2.96%/年,較治療前(5.95%/年)明顯降低。Fistulatype部分治療后遠(yuǎn)期加重病例10例,包括逐漸加重6例,突發(fā)加重4例,其部分治療后年突發(fā)加重率為1.46%/y,較治療前(5.76%/年)顯著降低。治療相關(guān)并發(fā)癥共43例,其中Nidus-type 30例,Fistula-type 13例,在部分治療的Nidus-type病例中并發(fā)癥的發(fā)生率隨著病變閉塞比例增高而升高。復(fù)合手術(shù)組的Nidus-type病例的臨床特點(diǎn)及病變結(jié)構(gòu)與非復(fù)合手術(shù)組相比較無(wú)顯著差異,但解剖治愈率更高(63.6%V.S 42.2%)并且兩組并發(fā)癥發(fā)生率相當(dāng)(27.3%V.S28.1%);復(fù)合手術(shù)組的Fistula-type病例供血?jiǎng)用}來(lái)源與非復(fù)合手術(shù)組相比更加復(fù)雜,但兩者的解剖治愈率持平(77.8%V.S 78.2%)并且復(fù)合手術(shù)組的并發(fā)癥發(fā)生率更低(11.1%V.S 19.6%)。研究結(jié)論突發(fā)起病的病例,無(wú)論是Nidus-type還是Fistula-type均不應(yīng)在急性期進(jìn)行外科手術(shù)干預(yù),但應(yīng)該提倡早期行介入手術(shù)閉塞出血危險(xiǎn)結(jié)構(gòu)。而對(duì)于逐漸發(fā)病的病例應(yīng)提倡早期治療。目前的治療方法安全有效。但是對(duì)于結(jié)構(gòu)相對(duì)復(fù)雜的病變?cè)谔岣卟∽冮]塞率的同時(shí)會(huì)增加并發(fā)癥的風(fēng)險(xiǎn),而部分治療并不能將病變自身所帶來(lái)的脊髓損傷風(fēng)險(xiǎn)完全去除。復(fù)合手術(shù)可以安全的提高病變的全切率。
[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 鹵3.4 and 4.3 鹵3.4, respectively, and recovered to 2.8 鹵2.8 and 2.5 鹵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.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R744.1
本文編號(hào)：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 鹵3.4 and 4.3 鹵3.4, respectively, and recovered to 2.8 鹵2.8 and 2.5 鹵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.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R744.1
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