CAJ | 학술논문

目的探讨应用n-BCA胶介入栓塞创伤性颈动脉海绵窦的方法和安全性.方法回顾性分析应用液体胶介入栓塞治疗的11例创伤性颈动脉海绵窦瘘的患者,包括临床特点、治疗方法和疗效.结果本组11例患者中,因球囊移位或渗漏导致的栓塞术后复发3例;球囊或弹簧圈栓塞后瘘口残留4例;瘘口太小球囊无法进入海绵窦内3例;因碎骨片反复刺破球囊1例.栓塞所使用的n-BCA胶的浓度从25%～50%,其中4例在注胶过程中使用不可脱球囊经颈内动脉暂时封闭瘘口,7例没有采用保护措施.4例采用保护性球囊的患者中均无n-BCA粘住球囊或微导管,所有11例患者均无n-BCA胶返流入颈内动脉的现象,术后即刻造影均提示瘘口完全消失.1例患者术后出现患侧玻璃体出血,经手术清除积血后视力恢复;1例术后出现患侧外展神经麻痹,半年后自行恢复;1例伴有外伤性视神经损伤,术后视力未恢复,无其他介入相关并发症.临床随访3个月-5年,所有患者均无临床症状复发,均恢复正常生活.结论单独采用n-BCA胶或联合球囊或弹簧圈介入栓塞创伤性颈动脉海绵窦瘘是安全、有效的方法.
목적 탐토응용n-BCA효개입전새창상성경동맥해면두적방법화안전성.방법 회고성분석응용액체효개입전새치료적11례창상성경동맥해면두루적환자,포괄림상특점、치료방법화료효.결과 본조11례환자중,인구낭이위혹삼루도치적전새술후복발3례;구낭혹탄황권전새후루구잔류4례;루구태소구낭무법진입해면두내3례;인쇄골편반복자파구낭1례.전새소사용적n-BCA효적농도종25%～50%,기중4례재주효과정중사용불가탈구낭경경내동맥잠시봉폐루구,7례몰유채용보호조시.4례채용보호성구낭적환자중균무n-BCA점주구낭혹미도관,소유11례환자균무n-BCA효반류입경내동맥적현상,술후즉각조영균제시루구완전소실.1례환자술후출현환측파리체출혈,경수술청제적혈후시력회복;1례술후출현환측외전신경마비,반년후자행회복;1례반유외상성시신경손상,술후시력미회복,무기타개입상관병발증.림상수방3개월-5년,소유환자균무림상증상복발,균회복정상생활.결론 단독채용n-BCA효혹연합구낭혹탄황권개입전새창상성경동맥해면두루시안전、유효적방법.
Objective To explore the method and safety of endovascular treatment of traumatic direct carotid cavernous fistulas with n - Butyl - 2 - Cyanoacrylate. Method A total of 11 patients with traumatic direct carotid cavernous fistulas treated by endovascular embolization with n - Butyl -2 - Cyanoacrylate( n - BCA ) were retrospectively analyzed, including the clinical presentations, methods of treatment and results of follow - up. Results In the 11 patients treated with n - BCA embolization, 3 with recurrent fistula because of premature balloon deflation or migration,4 with residual fistula after the balloons or microcoils detached, 3 unable to guide balloon into the small fistulous orifice and 1 repeated puncture of the detachable balloon by the bony fragment. The concentration of n - BCA ranged from 25% to 50%,protective balloon was used in 4 cases and there was no adhesion fo the n - BCA to the protective balloon or the microcatheter or n - BCA reflux into the parent arteries. Complete angiographic obliteration was documented in all patients right after the embolization. There was no permanent procedure - related morbidity. Clinical cure was achieved in all case and the clinical follow - up period ranged from 3 months to 5 years, all the patients restored to their normal life. Conclusions Endovascular embolization with n - BCA is a safe,efficient method for the treatment of traumatic direct carotid cavernous fistulas when angiographic cure and parent artery preservation are not achieved by detachable balloon embolization.