术前栓塞联合显微手术治疗实质性小脑血管母细胞瘤的临床效果

Clinical effects of preoperative embolization combined with microsurgery in the treatment of substantive cerebellar hemangioblastoma

目的探讨分析术前栓塞联合显微手术治疗实质性小脑血管母细胞瘤的临床效果。方法将2010年4月-2016年4月武汉大学人民医院神经外科收治的46例小脑实质性血管母细胞瘤患者作为研究对象，根据不同的治疗方案将其分为术前栓塞组（22例）和对照组（24例）。记录两组病例的一般资料和相关手术指标，分析术前栓塞的安全性及有效性。结果术前栓塞组14例达到完全栓塞，其中1例发生栓塞并发症（脑出血），6例大部分栓塞，2例部分栓塞。其中20例显微镜下全切，且未损伤脑干及邻近正常组织结构，2例因肿瘤同脑干粘连紧密，未强行全切。对照组显微镜下全切18例，6例因肿瘤出血凶猛严重影响手术视野，未能全切，其中4例切除90％，2例切除80％，且不同程度地损伤周边正常脑组织。术前栓塞组手术时间[（6．79±1．53）h1、术中出血量[（459．24±25．17）mL]、输血量[（250．00±81．35）mL]均短于或少于对照组[（8．11±1．36）h、（938．62±30．93）mL、（472．00±132．18）mL]，差异均有统计学意义（P〈0．05）。结论术前栓塞联合显微手术治疗实质性小脑血管母细胞瘤能有效缩短手术时间，减少术中出血量和输血量，提高患者的预后。是一种安全、可靠、有效的辅助治疗手段，具有较高的临床应用价值。

Objective To investigate and analyze the clinical effects of preoperative embolization combined with micro- surgery in the treatment of substantive cerebellar hemangioblastoma. Methods A total of 46 patients with substantive cerebellar hemangioblastoma admitted to Department of Neurosurgery, Renmin Hospital of Wuhan University from April 2010 to April 2016 were selected as research objects, and they were divided into preoperative embolization group （22 cases） and control group （24 cases） according to different treatment methods. The general data and surgery-related in- dicators of the two groups were recorded, and the security and effectiveness of preoperative embolization were analyzed. Results In preoperative embolization group, there were 14 patients with complete embolization, including 1 patient with the complication of cerebral hemorrhage, 6 patients with most embolization and 2 patients with partial embolization. 20 patients got complete resection with microscope, without damaging hrainstem and adjacent normal tissues and struc- tures, 2 patients got most resection for the close adhesion of turnout and brainstem. In the control group, 18 patients got completely resection with microscope, 6 patients got partial resection because of the serious hemorrhage affecting the surgery field, among whom, 4 patients got 90% resection, 2 patients got 80% resection, with varying degrees of damage to the surrounding normal brain tissue. The operative time [（6.79±1.53） hi, intraoperative blood loss [（459.24±25.17） mL] and transfusion blood [（250.00±81.35） mL] in the preoperative embolization group were all shorter or less than those of control group [（8.11±1.36） h, （938.62±30.93） mL, （472.00±132.18） mL], the differences were statistically significant （P 〈 0.05）. Conclusion Preoperative embolization combined with microsurgery in the treatment of substantive cerebellar hemangioblastoma can effectively cut down the operative time, reduce the intraoperative blood loss and transfusion blood and improve the prognosis of patients, which is a secure, reliable and effective method of adju- vant therapy, with high clinical application values.