血管内栓塞联合手术切除治疗脑动静脉畸形87例【医学毕业论文设计】.doc

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1、医学论文•血管内栓塞联合手术切除治疗脑动静脉畸形87例作者：赵振伟，高国栋，秦怀洲，李永林，赵继培，陈玲【关键词】脑动静脉畸形关键词：脑动静脉畸形;血管内栓塞;手术摘要：目的探讨血管内栓塞联合手术切除治疗脑动静脉畸形的有效性.方法1999・03/2001・03采用血管内栓塞联合手术切除治疗脑动静脉畸形87例・79例以自发性颅内出血起病，4例为头痛，4例表现为癫痫•根据Spetzler-Martin计分标准，I级9例，U级11例，HI级12例，IV级43例，V级12例•血管内栓塞剂为NBCA，栓后显微外科手术切除.结果通过血管内栓塞治疗，57例达到75%以上的闭塞率，占66%.AVM

2、病灶闭塞在50%〜75%者22例，占25%，闭塞率小于50%者8例，占9%•栓后手术完全切除病灶82例，占94%，次全或大部切除5例，占6%•术后3例遗昭偏瘫或失语，死亡1例，术后并发症发生率为4.6%.结论血管内栓塞联合手术切除是治疗脑动静脉畸形的有效方法，特别是对大型动静脉畸形，治愈率高，致残率和死亡率低.Endovascularembolizationcombinedsurgeryfor87patientswithcerebralarteriovenousmalformationsAbstract:AIMTodiscusstheeffectofendovascularcm・b

3、olizntioncombinedsurgeryforcerebralarteriovenousmnl・fomniions(AVM).METHODSFromMarch1997toMarch2001‘87patientsweretreatedbyendovascularbolizationcombinedsurgery.79patientspresentedwithspontaneousintracranialhemorrhage?4withheadache?4withseizure.AccordingtoSpctzlcrandMartingradingscale59patients

4、wereGradeI5liasGradeII‘12asGradelD‘43asGradelV‘andl2asGradeV.EmbolicagentwasNBCA.Microsurgcrywasperformedinallpatientsfollowingtheendovascularembo1ization.RESULTSAfternidusdovascularembolizalion‘obiilerationralemorelhan75%ofAVMwereobtainedin57patients(66%)，thatbctwccn50%〜70%ofAVMniduswerein22(

5、25%)5andthatratelessthan50%ofAVMnidusin8(9%).Thelesionwasto-tailyremovedin82patients(94%)bysurgeryaftercm・bolization5subtotalorincompleteremovalwasachievedin5(6%)・Aftersurgery»3patientspresentedwithhemiparaly・sisoraphasiaandlpalienldied.Posl・operativecomplicationratewas4.6%.CONCLUSIONEndovascu

6、larembolizationcombinedsurgeryisaeffectivemethodforcerebralAVMwithahighcurerateandalowmorbidityandmortalily，cs・peciallyforlargeAVMs・0引言脑动静脉畸形(arteriovenousmalformations，AVM)最严重的表现是颅内出血，致残率和死亡率高〔1，2〕•明确诊断后需尽早治疗・作为有效治疗手段之一的显微外科手术对于大型复杂的脑AVM而言‘全切除率低'并发症多•通过血管内栓塞可闭塞AVM大部及主要供血动脉‘有利于手术切除病变.1对象和方法1.1

7、对象①病例资料:1997-03/2001-03脑AVM87（男48，女39）例，年龄4〜72（平均37.5）岁・79例有自发性颅内出血，4例反复发作性头痛，4例表现为癫痫.脑AVM病灶位于额叶23例，顶叶20例，颍叶15例，枕叶12例，基底节区6例，幕下11例.Spetzler-Martin分级I级9例,II级11例,皿级12例、IV级43例，V级12例，无VI级•②栓塞材料:氟基丙烯酸正丁酯（N-butyl-2-cyanoacrylate，NBCA/Histoacr