闭塞颈内动脉治疗颈动脉海绵窦瘘的中长期疗效随访

Long term follow up of carotid cavernous fistula patients treated with carotid occlusion

目的探讨治疗性闭塞颈内动脉对于颈动脉海绵窦瘘（CCF）患者的中长期疗效及影响。方法回顾2001年9月至2012年2月收治的CCF患者的临床资料及随访资料，分析其临床症状特点，统计闭塞颈内动脉的比例。期间收治CCF患者共96例，单纯型CCF81例、复杂型CCF15例。单纯型CCF患者中32例（39．5％）术中实施了颈内动脉闭塞术（闭塞ICA组），其余64例患者保全ICA（保全ICA组）。通过电话问卷和门诊复查的方式，在术后2周，3、6、12、36个月时进行随访。评价遗留症状对患者生活质量的影响，探讨治疗性闭塞颈内动脉对于CCF患者的中长期疗效。结果实施颈内动脉闭塞术的患者，术后2周3例尚遗留视力损害，其余患者眼部体征消失、改良Rankin量表（mRS评分）≤2分。术后12个月闭塞ICA组生存30例，随访头痛评分（HIT-6）高于50分的6例（20％）；保全ICA组生存54例，高于50分的5例（9％），2组差异无统计学意义（χ^2=1．955，P=0．162）。术后36个月随访生存质量量表评分（SF-36）显示在躯体疼痛，总体健康和活力3个维度，闭塞ICA组的平均得分分别为（73．6±18．4）、（55．2±18．0）、（49．1±18．7）分，保全ICA组分别为（78．0±16．1）、（59．3±16．5）、（52．8±19．5）分；2组相比，躯体疼痛（t=2．403，P=0．023），总体健康（t=2．043，P=0．040），活力（t=2．019，P=0．046）评分差异均有统计学意义。CTA未发现继发的颅内血管病变。结论闭塞海绵窦段颈内动脉对于CCF的治疗可行、有效，但有可能对患者的长期生存质量产生负面影响。

Objective To explore efficacy, durability and possible impacts on life quality of carotid occlusion treatment to carotid cavernous fistula （CCF） patients. Methods CCF patients since 2001 were retrospectively analyzed, the clinical features, 2 weeks post procedure mRS score and ratio of carotid occlusion were recorded. Headache impact test （HIT-6） and Short form health survey（SF-36） were used to assess impact of sequelae in patients＇ daily life, by phone call, questionnaire and clinic recheck. Results Total 96 cases were studied composed of 81 direct CCF and 15 dural AVF. Thirty-two direct CCF cases underwent carotid occlusion during procedure and many ophthalmologic signs but visual impairment got recovery after 2 weeks, the mRS score less than 2 were revealed. The one year post operation HIT-6 score more than 50 was more likely found in carotid occlusion cases comparing with those preserved carotid artery while the 3 year SF-36 scores of carotid occlusion cases revealed inferior to those with patent artery, especially in body pain, general health and vitality subscales. Conclusion Carotid occlusion seems to be a feasible, effective and durable alternative for CCF treatment, but which could play a negative role on quality of patients＇ life in the long run.