【摘要】：目的:通過回顧性臨床病例分析,探究單純顯微外科手術(shù)與復(fù)合手術(shù)(介入栓塞+顯微外科手術(shù))對出血性腦動靜脈血管畸形患者預(yù)后影響的差異。方法:1.資料來源與入組標(biāo)準(zhǔn):本研究所有的病例資料均來自2014年4月~2017年2月河北醫(yī)科大學(xué)第二醫(yī)院東院區(qū)神經(jīng)外科。入組標(biāo)準(zhǔn):(1)患者入院時根據(jù)病史、影像學(xué)資料或腰椎穿刺證實為腦實質(zhì)出血,蛛網(wǎng)膜下腔出血,腦室出血,硬膜下出血;(2)入院后全部經(jīng)MRA或/和CTA或/和DSA及手術(shù)探查證實為腦動靜脈血管畸形;凡符合上述標(biāo)準(zhǔn)即可診斷為出血性腦動靜脈血管畸形,共有41例納入本研究。2.病例分組:本研究分為復(fù)合手術(shù)組和單純顯微手術(shù)組,(1)復(fù)合手術(shù)組(15例):全麻下先行腦動靜脈血管畸形(cAVM)的介入栓塞,栓塞全部供血動脈或部分主要供血動脈后,即刻行畸形血管團(tuán)的顯微外科手術(shù)切除。(2)單純顯微手術(shù)組(26例):即全麻下開顱顯微外科手術(shù)切除cAVM。3.比較內(nèi)容與統(tǒng)計方法:分別對兩組患者的性別、年齡、畸形血管團(tuán)直徑、供血動脈、引流靜脈、是否伴發(fā)動脈瘤、cAVM的部位、Spetzler-Martin分級、天壇分級、史玉泉分級、術(shù)前NIHSS評分、術(shù)后NIHSS評分、術(shù)中出血量、術(shù)中輸血量、開顱手術(shù)時間、術(shù)后mRS評分、術(shù)后GOS評分等進(jìn)行總結(jié),應(yīng)用SPSS13.0軟件進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:復(fù)合手術(shù)組與顯微手術(shù)組在cAVM的部位(x~2=0.655,P=0.418),是否伴發(fā)動脈瘤(x~2=0.307,P=0.580),主要供血動脈(x~2=4.178,P=0.372)Spetzler-Martin分級(x~2=3.876,P=0.409)天壇分級(x~2=3.219,P=0.224);史玉泉分級(x~2=4.912,P=0.080)方面無統(tǒng)計學(xué)意義。表明兩組間具有可比性。復(fù)合手術(shù)組與顯微手術(shù)組在術(shù)中出血量(Z=-1.297,P=0.195)、術(shù)中輸血量(Z=-1.630,P=0.103)、手術(shù)時間(Z=-0.989,P=0.323)方面均無顯著性差異。復(fù)合手術(shù)組與顯微手術(shù)組在術(shù)后GOS評分(x~2=0.687,P=0.373),術(shù)后mRS評分(x~2=3.593,P=0.664)方面無顯著性差異。結(jié)論:1復(fù)合手術(shù)在術(shù)中出血量、術(shù)中輸血量、手術(shù)時間方面與顯微手術(shù)相比無明顯差異。2復(fù)合手術(shù)與顯微手術(shù)相比在患者預(yù)后方面無明顯差異。本組病例為單中心回顧性研究,病例數(shù)相對較少,可能存在病例偏差,其結(jié)論尚需多中心、前瞻性隨機(jī)病例對照研究證實。
[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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.12

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 袁波;譚李紅;譚莉;黃曉松;;介入栓塞與陀螺旋轉(zhuǎn)式~(60)鈷放射治療系統(tǒng)聯(lián)合治療顱內(nèi)巨大動靜脈畸形15例療效觀察[J];卒中與神經(jīng)疾病;2016年03期

2 張海峰;梁國標(biāo);于春泳;王曉剛;李志清;高旭;董玉書;郭學(xué)軍;;在復(fù)合手術(shù)室治療腦動靜脈畸形的初步探討[J];中國臨床神經(jīng)外科雜志;2016年04期

3 張亮;;血管內(nèi)介入栓塞治療腦血管畸形病的安全性及療效探討[J];當(dāng)代醫(yī)學(xué);2016年06期

4 周溱;周江;華贊;馬艷;劉亞;李羅清;許澤武;李芳;;Onyx膠栓塞治療腦動靜脈畸形21例臨床分析[J];中國實用神經(jīng)疾病雜志;2012年20期

5 郭鵬;趙繼宗;;腦動靜脈畸形3094例的臨床特征及外科治療效果分析[J];中華醫(yī)學(xué)雜志;2011年39期

6 劉鳴;華續(xù)明;江峰;萬亮;王旭輝;仲駿;李世亭;;血管內(nèi)栓塞治療腦動靜脈畸形的臨床探討[J];中華神經(jīng)外科疾病研究雜志;2008年05期

7 姬馨彤;姜除寒;常文海;殷建軍;;腦動靜脈畸形合并動脈瘤的血管內(nèi)治療[J];中國煤炭工業(yè)醫(yī)學(xué)雜志;2007年12期

8 白如林;黃承光;陳懷瑞;王洋;盧亦成;;腦動靜脈畸形治療的目標(biāo)及策略[J];中華神經(jīng)外科雜志;2006年08期

9 趙繼宗,王碩,隋大立,李京生,張巖,李健;2086例腦動靜脈畸形臨床特征和手術(shù)治療結(jié)果分析[J];中華神經(jīng)外科雜志;2004年02期

10 胡小吾,周曉平,王來興,肖作平,劉永明,付少華,劉建民,洪波;X刀治療腦血管畸形(附45例臨床分析)[J];第二軍醫(yī)大學(xué)學(xué)報;2001年08期

相關(guān)碩士學(xué)位論文 前1條

1 李江安;腦動靜脈畸形的自然史[D];首都醫(yī)科大學(xué);2005年

，

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