高压锅技术在介入治疗硬脑膜动静脉瘘中的应用研究(1)
摘 要：目的 探讨高压锅技术栓塞硬脑膜动静脉瘘的可行性及预后。方法 收集重庆医科大学附属第一医院2015年9月～2017年6月应用高压锅技术介入栓塞治疗硬脑膜动静脉瘘的病例17例，根据病变部位对病例分类，术中、术后造影评估手术效果，改良Rankin量表评估预后。结果 17例硬脑膜动静脉瘘患者使用高压锅技术经动脉途径行血管内治疗，术后即刻造影，11例患者(64.71%)完全栓塞，6例患者(35.29%)残存少许微小供血动脉。无危险吻合、出血、缺血、面神经麻痹等并发症。术后6个月随访，mRs评分0分12例(70.59%)，1分5例(29.41%)。结论 以高压锅技术经动脉途径栓塞硬脑膜动静脉瘘是安全有效的，手术效果及预后佳，术后无明显并发症，短期随访效果佳，长期疗效有待进一步随访，操作中仍需注意危险吻合。
关键词：高压锅技术；硬脑膜动静脉瘘；经动脉栓塞
中图分类号：R743.4 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.07.065
, 百拇医药
文章编号：1006-1959(2018)07-0181-03
The Application of High Pressure Pot Technique in the Interventional Treatment of Dural Arteriovenous Fistula
ZHANG Zhen-yin，ZHANG Xiao-dong，XU Rui，ZHU ji，SUN Xiao-chuan
(Department of Neurosurgery，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，China)
Abstract：Objective To investigate the feasibility and prognosis of the high pressure pot technique for the embolization of the dural arteriovenous fistula.Methods Collection of the First Affiliated Hospital of Chongqing Medical University from September 2015 to June 2017.17 cases of dural arteriovenous fistula were treated with an the high pressure pot technique to treat embolism.Classification of cases was based on the lesion location，and the intraoperative and postoperative angiography was used to evaluate the surgical outcome. Modified Rankin scale to assess prognosis.Results 17 patients with dural arteriovenous fistulas were treated with endovascular treatment via arterial route by the high pressure pot technique.Immediately after angiography，11 patients (64.71%)were completely embolized and 6 patients(35.29%)survived.No risk of anastomosis，bleeding， ischemia，facial nerve paralysis and other complications.After 6 months of follow-up，the mRs score was 0 points in 12 cases(70.59%)，1 in 5 cases(29.41%).Conclusion The arterial embolization of dural arteriovenous fistula by the high pressure pot technique is safe and effective.The surgical outcome and prognosis are good.There is no obvious postoperative complications.The short-term follow-up results are good.Long-term efficacy needs further follow-up.Dangerous anastomosis is still required during operation.
, 百拇医药
Key words：High pressure pot technique；Dural arteriovenous fistula；Transcatheter arterial embolization
硬腦膜动静脉瘘(dural arteriovenous fistula，dAVF)是海绵窦、侧窦、矢状窦等其附近动静脉间的异常交通，为颅内外供血动脉与颅内静脉窦沟通。血管内治疗dAVF，大体上可分为经动脉途径和静脉途径。以栓塞导管到达瘘口，从而确保液态栓塞剂可以弥散至引流静脉端，完全闭塞引流静脉，彻底治愈dAVF。有研究认为，静脉途径比动脉途径更安全，且具有更高的即刻完全栓塞率。但随着高压锅技术(pressure cooker technique，PCT)的出现，动脉端使用诸如球囊导管进行栓塞，也可以在很好地控制反流的前提下，很好地将Onyx弥散至瘘口。本文收集重庆医科大学附属第一医院2014年9月～2017年6月应用高压锅技术介入栓塞硬脑膜动静脉瘘的病例17例，对其安全性、有效性分析如下。, http://www.100md.com(张振寅 张晓冬 徐睿 朱继 孙晓川)
关键词：高压锅技术；硬脑膜动静脉瘘；经动脉栓塞
中图分类号：R743.4 文献标识码：B DOI：10.3969/j.issn.1006-1959.2018.07.065
, 百拇医药
文章编号：1006-1959(2018)07-0181-03
The Application of High Pressure Pot Technique in the Interventional Treatment of Dural Arteriovenous Fistula
ZHANG Zhen-yin，ZHANG Xiao-dong，XU Rui，ZHU ji，SUN Xiao-chuan
(Department of Neurosurgery，the First Affiliated Hospital of Chongqing Medical University，Chongqing 400016，China)
Abstract：Objective To investigate the feasibility and prognosis of the high pressure pot technique for the embolization of the dural arteriovenous fistula.Methods Collection of the First Affiliated Hospital of Chongqing Medical University from September 2015 to June 2017.17 cases of dural arteriovenous fistula were treated with an the high pressure pot technique to treat embolism.Classification of cases was based on the lesion location，and the intraoperative and postoperative angiography was used to evaluate the surgical outcome. Modified Rankin scale to assess prognosis.Results 17 patients with dural arteriovenous fistulas were treated with endovascular treatment via arterial route by the high pressure pot technique.Immediately after angiography，11 patients (64.71%)were completely embolized and 6 patients(35.29%)survived.No risk of anastomosis，bleeding， ischemia，facial nerve paralysis and other complications.After 6 months of follow-up，the mRs score was 0 points in 12 cases(70.59%)，1 in 5 cases(29.41%).Conclusion The arterial embolization of dural arteriovenous fistula by the high pressure pot technique is safe and effective.The surgical outcome and prognosis are good.There is no obvious postoperative complications.The short-term follow-up results are good.Long-term efficacy needs further follow-up.Dangerous anastomosis is still required during operation.
, 百拇医药
Key words：High pressure pot technique；Dural arteriovenous fistula；Transcatheter arterial embolization
硬腦膜动静脉瘘(dural arteriovenous fistula，dAVF)是海绵窦、侧窦、矢状窦等其附近动静脉间的异常交通，为颅内外供血动脉与颅内静脉窦沟通。血管内治疗dAVF，大体上可分为经动脉途径和静脉途径。以栓塞导管到达瘘口，从而确保液态栓塞剂可以弥散至引流静脉端，完全闭塞引流静脉，彻底治愈dAVF。有研究认为，静脉途径比动脉途径更安全，且具有更高的即刻完全栓塞率。但随着高压锅技术(pressure cooker technique，PCT)的出现，动脉端使用诸如球囊导管进行栓塞，也可以在很好地控制反流的前提下，很好地将Onyx弥散至瘘口。本文收集重庆医科大学附属第一医院2014年9月～2017年6月应用高压锅技术介入栓塞硬脑膜动静脉瘘的病例17例，对其安全性、有效性分析如下。, http://www.100md.com(张振寅 张晓冬 徐睿 朱继 孙晓川)