硬脊膜动静脉瘘的治疗及预后相关因素分析

Analysis of treatment and prognostic factors of spinal dural arteriovenous fistula

目的:分析血管内栓塞及显微外科手术治疗硬脊膜动静脉瘘(SDAVF)的疗效、复发率,探讨其预后的相关因素。方法:回顾性分析44例SDAVF患者的临床资料。34例患者接受血管内栓塞治疗,10例患者接受显微外科手术治疗,比较两种治疗方式的治疗效果及复发率,并对SDAVF患者的预后因素进行分析。结果:显微外科手术治疗组中临床治愈7例,改善1例,无变化2例,无患者复发。血管内栓塞治疗组中临床治愈20例,改善4例,无变化8例,恶化或加重2例;6例患者在术后9个月内复发。两组疗效及复发率差异无统计学意义(P>0.05)。确诊时间、术前脊髓水肿程度与SDAVF预后有关。结论:血管内栓塞和显微外科手术均为治疗SDAVF的有效方法,个体化治疗有助于提高临床疗效。确诊时间、术前脊髓水肿程度是SDAVF患者预后的独立因素。

Aim： To analyze the efficacy and recurrence rate of endovascular embolization and microsurgery in treating spinal dural arteriovenous fistula（ SDAVF） and to explore the related prognostic factors of SDAVF. Methods： The clinical data of 44 patients with SDAVF were retrospectively analyzed. There were 34 patients accepting endovascular therapy,and10 patients accepting microsurgical therapy. The efficacy and recurrence rate of the two treatment methods were compared,and the prognostic factors were analyzed. Results： There were 7 cases obtained clinical cure in microsurgical treatment group,1 case improved,and 2 cases had no significant change. There were 20 cases obtained clinical cure in endovascular treatment group,4 cases improved,8 cases had no significant change,and 2 cases suffered from deterioration. There were6 cases who underwent endovascular treatment suffered from recurrence within 9 months after surgery. There was no significant difference in the efficacy or recurrence rate between the two groups. The prognosis of SDAVF were related to the time of confirmed diagnosis and the extent of spinal cord edema. Conclusion： Endovascular embolization and microsurgical treatment are both effective therapy of SDAVF. Both the time of confirmed diagnosis and the extent of spinal cord edema are prognostic factors of SDAVF.