發(fā)布時(shí)間：2018-06-03 19:37

  本文選題：硬脊膜動(dòng)靜脈瘺 + 數(shù)字減影血管造影　； 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的 探討經(jīng)半-半椎板顯微入路手術(shù)治療硬脊膜動(dòng)靜脈瘺(SDAVF)的有效性及可行性,為硬脊膜動(dòng)靜脈瘺的治療提供一種新的微創(chuàng)方法。 方法 回顧分析我科2006年1月至2014年1月收治的32例硬脊膜動(dòng)靜脈瘺患者的臨床資料。術(shù)前行MRI檢查及血管造影確診,其中男性病例27例,女性病例5例,男女比例5.4：1,平均年齡51.43歲,平均病程12.6月。其中14例患者經(jīng)半-半椎板顯微入路手術(shù)治療,其余18例患者經(jīng)傳統(tǒng)全椎板入路手術(shù)治療。兩組數(shù)據(jù)進(jìn)行t檢驗(yàn)。 結(jié)果 硬脊膜動(dòng)靜脈瘺瘺口位于胸段18例,腰段12例,頸段2例。瘺口均為單動(dòng)脈供血。14例患者經(jīng)半-半椎板顯微入路手術(shù)治療,手術(shù)平均時(shí)間為101.86分鐘,失血量平均為81.43m1,術(shù)后住院時(shí)間平均為13天,住院費(fèi)用平均為24284.36元。余18例患者采用傳統(tǒng)全椎板入路手術(shù)治療,其中部分患者為我科開展微創(chuàng)手術(shù)之前患者,部分患者為不能精確定位瘺口和瘺口位于頸段。該18例患者手術(shù)平均時(shí)間為138.61分鐘,失血量平均為130.56m1,術(shù)后住院時(shí)間平均為16天,住院費(fèi)用平均為28098.89元。兩組數(shù)據(jù)進(jìn)行t檢驗(yàn),P0.05有統(tǒng)計(jì)學(xué)差異。經(jīng)半-半椎板顯微入路手術(shù)夾閉瘺口與傳統(tǒng)手術(shù)方式相比較,再不增加手術(shù)并發(fā)癥的前提下手術(shù)時(shí)間短、出血量少,患者住院時(shí)間及費(fèi)用少。出院后隨訪6個(gè)月至2年,患者術(shù)后癥狀均較前術(shù)前好轉(zhuǎn)。 結(jié)論 硬脊膜動(dòng)靜脈瘺(SDAVF)是脊髓血管畸形中最常見的一種類型,臨床表現(xiàn)缺乏特異性,診斷首選DSA。手術(shù)治療硬脊膜動(dòng)靜脈瘺是一種有效的方法。在術(shù)前行脊髓血管造影精確定位瘺口位置的前提下,且瘺口位于胸腰段時(shí),經(jīng)半-半椎板顯微入路手術(shù)夾閉瘺口安全可行,且手術(shù)創(chuàng)傷更小,有利于脊柱穩(wěn)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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 牛胤;蔣周陽;繆洪平;馮華;陳志;朱剛;;吲哚菁綠血管造影在硬脊膜動(dòng)靜脈瘺手術(shù)中的應(yīng)用價(jià)值[J];第三軍醫(yī)大學(xué)學(xué)報(bào);2013年18期

2 鄭宇;張鴻祺;;顱頸交界區(qū)硬脊膜動(dòng)靜脈瘺與其他部位硬脊膜動(dòng)靜脈瘺的比較研究[J];臨床合理用藥雜志;2012年19期

3 戚躍勇,孫清榮,梁開運(yùn),鄒利光,熊坤林,周政,何作云;硬脊膜動(dòng)靜脈瘺血液動(dòng)力學(xué)改變的血管造影表現(xiàn)[J];中國血液流變學(xué)雜志;2004年01期

4 梁朝輝;張鴻祺;焦保華;支興龍;李萌;凌鋒;;硬脊膜動(dòng)靜脈瘺誤診誤治33例報(bào)告[J];中國神經(jīng)精神疾病雜志;2011年01期

5 張茂;張鴻祺;葉明;;顱頸交界區(qū)硬脊膜動(dòng)靜脈瘺的診治分析[J];中國微侵襲神經(jīng)外科雜志;2009年09期

6 李世鵬;張彥芳;莫大鵬;鮑圣_，

本文編號(hào)：1973935