复合手术室在脑脊髓血管病和富血供肿瘤治疗中的应用

The application of hybrid operation suite in the management of cerebral and spinal vascular diseases and intracranial hypervascular tumors

目的探讨复合手术室在脑脊髓血管疾病和富血供肿瘤治疗中的应用价值。方法回顾性分析2016年10月至2017年12月于复旦大学附属华山医院神经外科复合手术室接受手术治疗的连续132例患者资料。其中男性70例,女性62例,年龄48.33岁(范围:14~78岁)。132例患者中,颅内动脉瘤64例,其中64%为复杂动脉瘤,脑动静脉畸形(BAVM)28例,富血供肿瘤12例,硬脑膜动静脉瘘(DAVF)12例,颈动脉狭窄6例,烟雾病5例,动脉瘤合并BAVM或颅内肿瘤3例,头皮动静脉瘘1例,脑外伤近颅底血管环颅内金属异物1例。对病例治疗的成功率、死亡率、病残率、感染率及住院时间、费用进行统计分析。结果64例动脉瘤手术总体闭塞率为90.5%,病死率为4.7%,致残率为14.0%;28例BAVM患者病灶全部闭塞或切除,无患者死亡或出现神经功能障碍;12例DAVF患者瘘口均切断,未出现并发症;6例颈动脉狭窄与5例烟雾病手术均成功,无患者出现新发神经功能障碍;12例富血供肿瘤患者中仅4例术中输血,1例延髓血管母细胞瘤患者术后因呼吸功能障碍死亡;其他病例手术均安全实施,病灶消除,未见并发症。共有16例患者在术中脑血管造影中发现异常。复合手术与传统开颅手术比,在总体感染率、中枢神经系统感染率、住院时间和术后住院时间等方面无统计学意义(P值均>0.05),住院费用有所增加(119 332元比98 215元,t=2.38,P=0.02)。结论复合手术能够在脑脊髓血管疾病和富血供肿瘤手术治疗中安全开展,治疗效果满意并有利于开展高难度新手术。

Objective To evaluate the effect of hybrid operation suite in the treatment of cerebral and spinal vascular diseases and intracranial hypervascular tumors. Methods A retrospective study was conducted on 132 patients with various cerebral and spinal vascular diseases and intracranial hypervascular tumors who were treated by hybrid surgery at Department of Neurosurgery, Huashan Hospital from October 2016 to December 2017.There were 70 male and 62 female patients with a mean age of 48.33 years (range: 14-78 years), including 64 cases of intracranial aneurysm (41 complicated aneurysm cases), 28 cases of brain arteriovenous malformation (BAVM), 12 cases of hypervascular tumor, 12 cases of dural arteriovenous fistula (DAVF), 6 cases of carotid artery stenosis, 5 cases of Moyamoya disease, 3 cases of intracranial aneurysm or BAVM combined with tumor, 1 case of scalp arteriovenous fistula and 1 case of critical brain trauma in which a foreign metal stick approached the basal vascular circuit.Abnormalities were found in 16 cases in intraoperative angiography. The clinical data of all patients was collected as a perspective cohort. The success rate of hybrid surgery, intra-operative and post-operative complications, morbidity, mortality, rate of infection, the length of hospital stay were all analyzed to illustrate the effect of hybrid operation mode to traditional surgical pattern. Results For 64 cases with intracranial aneurysms, the immediate complete occlusion rate was 90.5%, with a mortality of 4.7% and a morbidity of 14.0%. For 28 cases of BAVM and 12 cases of DAVF, all patients achieved total obliteration and favorable social independent outcomes after hybrid surgery, with no complication.For 6 cases of carotid artery stenosis and 5 cases of Moyamoya, intra-operative confirmed good cerebral reperfusion without any new post-operative neurologic deficits. After tumor vessels embolization, 4 out of 12 cases of hypervascular tumor needed intra-operative blood transfusion, and all patients achieved total tumor resection in a single stage. Only one patient with medulla oblongata hemangioblastoma died 6 months after operation due to respiratory deficit related pneumonia. Compared to traditional surgeries, the hybrid operation pattern did not significantly increase the total infection rate, central nervous system infection rate, hospital stay days and post-operative hospital stay days (all P>0.05) while the in-patient cost increased mildly (119 332 yuan vs.98 215 yuan, t=2.38, P=0.02). Conclusions The operations of complex cerebral and spinal vascular diseases and intracranial hypervascular tumors can be performed in hybrid operation suite safely.This surgical mode can ensure the quality of operation and promote the development of innovative and complicated surgical procedures.