外伤性颈动脉海绵窦瘘治疗后动眼神经麻痹恢复时间的影响因素分析

The analysis of influence factor on the recovery time of oculomotor nerve palsy after traumatic carotid-cavernous sinus fistula treated by balloon embolization

目的 探讨外伤性颈动脉海绵窦瘘（TCCF）导致的动眼神经麻痹（ONP）经血管内球囊栓塞治疗后动眼神经功能恢复时间的影响因素.方法 回顾性分析76例TCCF导致的ONP患者的临床资料,所有患者均接受血管内球囊栓塞治疗.采用非参数检验进行ONP恢复时间影响因素的单因素分析,采用多元线性回归分析做多因素分析.结果 76例术后即刻造影显示瘘口完全闭塞,73例（96.1％）患者保留颈内动脉.术后随访6 ～ 70个月,平均34.2个月,无死亡病例,有70例（92.1％）患者1次栓塞成功,6例（7.9％）患者于第1次栓塞治疗后6周内复发,复发原因为球囊泄露,再次栓塞后未再复发.76例（100.0％）患者ONP完全恢复,恢复时间为（42.17±32.39）d.单因素分析结果显示：病程、瘘口位置、眼突位置、ONP程度、球囊使用数量、颈内动脉状态是TCCF患者ONP恢复时间的影响因素（P＜ 0.01或＜0.05）;多元线性回归分析结果显示：病程、瘘口位置、ONP程度、球囊使用数量是ONP恢复时间的独立影响因素（P＜0.01）.结论 血管内球囊栓塞治疗TCCF导致的ONP,安全可靠.病程、瘘口位置、ONP程度及球囊使用数量是术后动眼神经功能恢复时间的影响因素,应给予足够重视.

Objective To investigate the influence factor of the recovery time of oculomotor nerve palsy （ONP） after traumatic carotid-cavernous sinus fistula （TCCF） treated by balloon embolization.Methods The clinical data of 76 patients with ONP after TCCF were retrospectively analyzed.All patients accepted intravascular balloon embolization treatment.Nonparametric test was applied to make single factor analysis of the influence factor of ONP recovery time,and linear regression analysis was applied to make multiple factor analysis.Results Seventy-six patients （100.0%） had a perfect occlusion for orificium fistulae after operation immediately,and 73 patients （96.1%） retained the internal carotid artery.Patients were followed up for 6-70 months,with an average of 34.2 months and no death cases.Seventy patients （92.1%） succeeded for embolization at the first time,and 6 patients （7.9%） relapsed after embolization for 6 weeks.The reasons of relapse was balloon leak,and no patients recurred after twice embolization.Seventy-six patients （100.0%） had recovery from ONP,and recovery time was （42.17 ± 32.39） d.The single factor analysis showed that the courses of diseases,fistula location,eye-tubercle location,degree of ONP,balloon quantity,state of internal carotid artery were the factor affecting the ONP recovery time （P 〈 0.01 or 〈 0.05）.The linear regression analysis showed that the courses of the disease,fistula location,degree of ONP,balloon quantity were independent factor affecting the ONP recovery time （P 〈 0.01）.Conclusions Intravascular balloon embolization in the treatment of ONP after TCCF is safe and reliable.The courses of diseases,fistula location,degree of ONP and balloon quantity are the influencing factor of the oculomotor nerve functional recovery time,and should be given enough attention.