脑动静脉畸形破裂出血的急诊手术治疗

Emergency Surgery for Cerebral Hemorrhage Induced by Rupture of Cerebral Arteriovenous Malformation

目的探讨脑动静脉畸形(AVM)破裂出血急诊手术治疗的策略。方法回顾分析黄山市人民医院32例AVM破裂出血急诊手术治疗的病历资料。病变位于额叶5例,颞叶12例,顶叶9例,枕叶4例,小脑半球2例。结果血肿清除加AVM全切除17例,血肿清除加供血动脉夹闭、部分AVM切除9例,单纯血肿清除或脑室引流6例、加AVMⅡ期治疗4例(包括手术切除、介入栓塞及伽玛刀治疗),死亡2例。存活病例中术后按日常生活能力分级法(ADL)分级评价:Ⅰ级10例,Ⅱ级11例,Ⅲ级7例,Ⅳ级2例。结论脑动静畸形破裂出血患者,在严重意识障碍或已出现脑疝的情况下需急诊清除血肿,同时尽可能地进行AVM全切除;而对于AVM处于功能区、脑深部或巨大AVM患者,在安全的前提下应尽可能地夹闭AVM的供血动脉或切除畸形血管团,或仅清除血肿待病情稳定后Ⅱ期治疗。

Objective To explore the strategy of emergency operation for cerebral hemorrhage induced by the rupture of cerebral arteriovenous malfunction（AVM）.Methods The medical records of 32 patients with emergency operation after the rupture of AVM were retrospectively analyzed.Of 32 patients,5 had AVM in the frontal lobe,12 in the temporal lobe,9 in the parietal lobe,4 in the occipital lobe and 2 in the cerebellar hemisphere.Results Seventeen patients were treated by removing hematoma and complete resection of AVM;9 patients by removing hematoma,occlusion of feeding arteries,and partial resection of AVM;6 patients by merely removing hematoma or ventricular drainage;4 patients received phase Ⅱ treatments following hematoma-removing or ventricular drainage;2 patients died during the treatments.Of the survived patients,10 were ranked grade Ⅰ,11 were ranked grade Ⅱ,7 were ranked grade Ⅲ,and 2 were ranked graded Ⅳ,according to the activities of daily life.Conclusion If the patients with cerebral hemorrhage induced by rupture of AVM have serious disturbance of consciousness or cerebral hernia,they should be treated by emergency operation for removing hematoma and complete resection of AVM as far as possible;while the patients with AVM located in functional zones,the deep parts of brain,or with huge AVM,should be treated by the occlusion of feeding arteries of AVM or the resection of AVM as far as possible for the purpose of safety,or be treated by merely removing hematoma for phase Ⅱ treatments after the condition of patients getting stable.