温州医科大学学报
溫州醫科大學學報
온주의과대학학보
Journal of Wenzhou Medical University
2014年
11期
846-848
,共3页
张毅%李则群%龙彦笑%钟鸣%鲁祥和%郑伟明
張毅%李則群%龍彥笑%鐘鳴%魯祥和%鄭偉明
장의%리칙군%룡언소%종명%로상화%정위명
后颅窝%血管畸形%手术%血管内治疗
後顱窩%血管畸形%手術%血管內治療
후로와%혈관기형%수술%혈관내치료
posterior fossa%vascular malformation%surgical strategy%endovascular treatment
目的：探讨后颅窝血管畸形出血的外科治疗方式及其疗效。方法：收集2008年1月至2013年10月在我科住院手术治疗的后颅窝出血、有明确术前影像学诊断和术后病理学诊断的血管畸形患者共24例（动静脉畸形15例，毛细血管扩张1例，静脉畸形2例，硬脑膜动静脉瘘6例），7例为蛛网膜下腔出血，17例为后颅窝血肿，结合手术记录、术后随访进行回顾性分析。结果：动静脉畸形11例开颅动静脉畸形切除+血肿清除，2例行栓塞治疗，2例手术+立体定向放射治疗；毛细血管扩张和静脉畸形行血肿清除、畸形血管切除；硬脑膜动静脉瘘4例行栓塞治疗，1例行血肿清除+二期栓塞治疗，1例行硬脑膜瘘切除术。本组1例动静脉畸形破裂出血患者术前深昏迷，术后死亡；1例静脉畸形患者术前脑疝、术后生命体征不稳而自动出院；其余患者术后及随访（3～54个月）示好转或痊愈。结论：个体化的综合治疗是后颅窝血管畸形破裂出血的治疗趋势，可提高疗效，改善预后。
目的：探討後顱窩血管畸形齣血的外科治療方式及其療效。方法：收集2008年1月至2013年10月在我科住院手術治療的後顱窩齣血、有明確術前影像學診斷和術後病理學診斷的血管畸形患者共24例（動靜脈畸形15例，毛細血管擴張1例，靜脈畸形2例，硬腦膜動靜脈瘺6例），7例為蛛網膜下腔齣血，17例為後顱窩血腫，結閤手術記錄、術後隨訪進行迴顧性分析。結果：動靜脈畸形11例開顱動靜脈畸形切除+血腫清除，2例行栓塞治療，2例手術+立體定嚮放射治療；毛細血管擴張和靜脈畸形行血腫清除、畸形血管切除；硬腦膜動靜脈瘺4例行栓塞治療，1例行血腫清除+二期栓塞治療，1例行硬腦膜瘺切除術。本組1例動靜脈畸形破裂齣血患者術前深昏迷，術後死亡；1例靜脈畸形患者術前腦疝、術後生命體徵不穩而自動齣院；其餘患者術後及隨訪（3～54箇月）示好轉或痊愈。結論：箇體化的綜閤治療是後顱窩血管畸形破裂齣血的治療趨勢，可提高療效，改善預後。
목적：탐토후로와혈관기형출혈적외과치료방식급기료효。방법：수집2008년1월지2013년10월재아과주원수술치료적후로와출혈、유명학술전영상학진단화술후병이학진단적혈관기형환자공24례（동정맥기형15례，모세혈관확장1례，정맥기형2례，경뇌막동정맥루6례），7례위주망막하강출혈，17례위후로와혈종，결합수술기록、술후수방진행회고성분석。결과：동정맥기형11례개로동정맥기형절제+혈종청제，2례행전새치료，2례수술+입체정향방사치료；모세혈관확장화정맥기형행혈종청제、기형혈관절제；경뇌막동정맥루4례행전새치료，1례행혈종청제+이기전새치료，1례행경뇌막루절제술。본조1례동정맥기형파렬출혈환자술전심혼미，술후사망；1례정맥기형환자술전뇌산、술후생명체정불은이자동출원；기여환자술후급수방（3～54개월）시호전혹전유。결론：개체화적종합치료시후로와혈관기형파렬출혈적치료추세，가제고료효，개선예후。
Objective: To discuss the surgical strategy and curative effect of vascular malformation hem-orrhage of posterior fossa.Methods: The clinical data of 24 patients, from January 2008 to October 2013, with vascular malformation hemorrhage of posterior fossa were analyzed retrospectively. All patients received preop-erative imaging scaning and/or pathologic diagnosis, 15 with arteriovenous malformation, 1 with telangiectasis, 2 with venous malformation, and 6 with dura arteriovenous ifstulas (DAVF). Seven cases suffered with subarach-noid hemorrhage (SAH) and 17 cases had posterior fossa hematoma.Results: Eleven cases of the arteriovenous malformation got arteriovenous malformation resection and hematoma evacuation, 2 were treated with endovas-cular embolization and another 2 got radiotherapy after part arteriovenous malformation resection. The telangiec-tasis cases and venous malformation patients were performed hematoma evacuation. Four DAVF patients got em-bolization and 1 got two-stage embolization after hematoma evacuation, and 1 got DAVF excision. Patients were followed up for a period from 6 months to 54 months. Of these patients, the curative effect was excellent in 22, bad in 2.Conclusion: Individualized comprehensive treatment of vascular malformation hemorrhage of posterior fossa can improve efifcacy and prognosis.
