外伤性颈动脉海绵窦瘘血管内治疗及其并发症防治

Endovascular treatment of traumatic carotid cavernous fistulas and prevention of its complication (report of 37 cases)

目的探讨外伤性颈动脉海绵窦瘘(TCCF)血管内治疗的临床疗效、并发症产生的原因及防治措施。方法 2009年1月至2011年3月收治37例TCCF患者,单纯应用可脱球囊栓塞治疗31例,带膜支架植入治疗5例,1例未治疗自动出院。结果 36例患者全部血管内治疗成功,31例闭塞瘘口并保持颈内动脉通畅,5例行可脱球囊闭塞瘘口同时永久闭塞患侧颈内动脉;术中出现颈内动脉痉挛3例,术后脑缺血1例,高灌注3例,颈内动脉狭窄1例,均经对症治疗后均痊愈;2例术后第3天、第6天复发,再次行可脱球囊闭塞瘘口治愈。本组无手术死亡。术后随访2～6个月,均无瘘口再通,患者均恢复良好。结论单纯可脱球囊栓塞治疗TCCF效果良好,在可脱球囊治疗困难时,选用带膜支架植入治疗也是一个良好的选择;在降低血压情况下颈内动脉闭塞试验是评价能否可闭塞颈内动脉的金标准。预防并发症发生、处理好术后并发症可进一步提高治愈率。

Objective To explore the curative effect of endovascular embolization on traumatic carotid cavernous fistulas （TCCFs）,the causes of its complications and method to treat and prevent them.Methods Of 37 patients with TCCFs,who were treated from January,2009 to March,2011,31 received endovascular embolization only with detachable balloons and 5 with the covered stents.Results TCCFs were successfully occluded in 36 patients,but the internal carotid artery （ICA） were occluded also in 5 patients.One patient refused surgical treatment and were dischanged from hospital.The ICA vasospasm was observed during the endovascular treatment in 3 patients.The cerebral ischemia occurred in 1 patient,the cerebral hypertrasfusion in 3,and ICA stenosis in 1 after the embolization.All the complications disappeared after the suitable treatment to them.TCCFs which recurred respectively 2 and 6 days after the first embolization in 2 patients were successfully occluded again with detachable balloons.The cured rate was 100%.No patients died.The following-up from 2 to 6 months showed that all the patients were recovered well.Conclusions The endovascular treatment with the detachable balloons should be considered as the first choice of treatment methods in patients with TCCFs.Covered stent should be used in the patient whose fistula can not be successfully occluded with detachable balloons.ICA occlusion test under the hypotension is the golden standard of the safety of ICA occlusion.The curative effect of the endovascular embolization on TCCFs may be further improved by the positive prevention and correct treatment of the complications.