本文選題：頸內動脈海綿竇瘺 + 介入治療�。� 參考：《山西醫(yī)科大學》2015年碩士論文

【摘要】：目的:頸內動脈海綿竇瘺(CCF)是指頸內動脈海綿竇段或頸內動脈海綿竇段的分支破裂,與海綿竇之間形成異常的動、靜脈溝通,臨床上可造成波動性突眼、顱內震顫與雜音、球結膜水腫、甚至致死性鼻衄等一系列癥狀。目前治療方法主要為開顱手術治療與介入治療,介入治療已發(fā)展成為治療CCF的首選手段。介入治療采用的主要材料有可脫球囊、彈簧圈、覆膜支架等,分別適用于不同情況下的頸內動脈海綿竇瘺。國內外學者對可脫球囊治療CCF研究較完善,覆膜支架用于介入治療CCF的相關報道較少。分析可脫球囊與覆膜支架在CCF介入治療中的應用,有助于臨床合理選擇治療方案,明確手術指征。明確可脫球囊與覆膜支架治療頸內動脈海綿竇漏的優(yōu)缺點及預后,為臨床工作選擇合適治療方案提供參考。方法:回顧性分析2010年3月-2013年12月間山西醫(yī)科大學第二醫(yī)院經(jīng)可脫球囊治療的頸內動脈海綿竇瘺病人9例,解放軍總醫(yī)院經(jīng)可脫球囊治療的頸內動脈海綿竇瘺病人8例,經(jīng)覆膜支架治療的頸內動脈海綿竇瘺病人5例,共22例CCF患者的臨床病例資料。通過統(tǒng)計學分析,評估可脫球囊及覆膜支架治療CCF的短期及遠期預后。結果:經(jīng)可脫球囊治療的病例術程順利,其中1例閉塞瘺口的同時栓塞了同側頸內動脈,術后患者無特殊癥狀,3個月復查頭顱MRI未見明顯腦萎縮。其余病例復查造影見瘺口封閉,同側頸內動脈血流通暢,術后患者顱內雜音即刻消失,術后3個月復查,1例患者患側頸內動脈狹窄,但血流代償良好,患者無任何癥狀。經(jīng)覆膜支架治療的病例支架全部置入成功,復查造影瘺口封閉,無內漏,術后3個月復查未復發(fā),同側頸內動脈通暢,未見狹窄。通過對臨床癥狀改善情況的統(tǒng)計學分析,P0.05,兩種治療方法均有效。結論:對于頸內動脈海綿竇的病人,經(jīng)可脫球囊介入栓塞治療仍是主要手段,但隨著相關技術的成熟,覆膜支架成為介入治療頸內動脈海綿竇瘺重要的有效手段。不同栓塞材料適用于不同情況下的頸內動脈海綿竇,對于部分病例還可采用多種栓塞材料聯(lián)合應用治療。
[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.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.1

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本文編號：1994049