神经介入技术在脑和脊髓富血运肿瘤治疗中的应用(附234例报告)

Application of neurointerventional technique in treatment of rich-vascularized tumor: A report of 234 cases

目的探讨神经介入技术在脑、脊髓富血运肿瘤(RVT)诊疗中的应用。方法回顾性分析2008年1月至2017年12月复旦大学附属华山医院神经外科集团上海普陀区人民医院神经外科收治的234例脑、脊髓RVT患者的临床资料。所有患者术前均行头颅CT、MRI、CT血管成像(CTA)或磁共振血管成像(MRA)检查,初步判断为可疑RVT。之后行数字减影血管造影(DSA)检查,评估肿瘤的血运、动静脉走行及受累情况,对于符合栓塞指征的患者进行介入治疗。术后行DSA评估血管栓塞效果,分为优、良、一般、差4个等级。术后1 d或6~9 d行肿瘤切除术。根据患者是否行介入治疗,分为介入治疗组和未介入治疗组。比较两组患者的术中出血量、术后并发症发生率及肿瘤完全切除率。结果234例患者中,56例(23.9%)无需栓塞,178例(76.1%)需要栓塞,其中127例(71.3%)存在适合栓塞的血管,另51例(28.7%)则无适合的血管。127例患者的栓塞结果,其中34例(26.7%)为优,62例(48.8%)为良,26例(20.5%)为一般,5例(4.0%)为差;总体栓塞有效率为96.1%(122/127)。术后3例出现并发症,其中2例为脑神经短暂性损伤,1例为卒中。234例患者中,127例为介入治疗组,107例为未介入治疗组;两组的性别、年龄、手术入路及病理学类型间的差异均无统计学意义(均P>0.05)。与未介入治疗组比较,介入治疗组患者的术中出血量少[分别为(571.3±100.3)ml、(1020.4±267.9)ml,P<0.001]、术后并发症发生率低[分别为4.7%(6/127)、12.1%(13/107),P=0.038]及肿瘤完全切除率高[分别为91.3%(116/127)、80.4%(86/107),P=0.015]。结论通过神经介入技术评估和治疗脑、脊髓RVT是安全、有效的,可有效减少肿瘤切除术中的出血量、提高肿瘤完全切除率及降低术后并发症的发生率。

Objective To investigate the role of neurointerventional technique in the diagnosis and treatment of cranial and spinal rich-vascularized tumor(RVT).Methods A retrospective analysis was conducted on the clinical data of 234 cases of RVT admitted to Department of Neurosurgery,Shanghai Putuo District People′s Hospital from January 2008 to December 2017.All patients underwent head CT,MRI,CT angiography(CTA)or magnetic resonance angiography(MRA)before surgery,and were initially judged as suspected RVT.Afterwards,digital subtraction angiography(DSA)was performed to evaluate the blood flow,arteriovenous distribution and involvement of the tumor,and further neurological intervention was performed for patients who met the embolization indication.Postoperative DSA was used to evaluate the embolization effect,which was divided into 4 grades(excellent,good,fair,poor).Tumor resection was performed 1 day or 6 to 9 days after embolization.According to whether the patient was treated with interventional therapy,he/she was divided into interventional treatment group and non-intervention treatment group.The intraoperative blood loss,postoperative complication rate and complete tumor resection rate were compared between the two groups.Results Of the 234 patients,56(23.9%)did not need embolization,and 178(76.1%)required embolization,of which 127(71.3%)had vessels suitable for embolization,and 51(28.7%)had no suitable vessels.The embolization results of 127 patients were excellent in 34 cases(26.7%),62 cases(48.8%)were good,26 cases(20.5%)were fair,and 5 cases(4.0%)were poor.The overall embolization rate was 96.1%(122/127).Complications occurred in 3 patients after operation,2 of which were transient neurological damage and 1 was stroke.Of the 234 patients,127 were in the interventional group and 107 were in the non-intervention group.There were no significant differences in gender,age,surgical approach or pathological type between the two groups(all P>0.05).Compared with patients without interventional therapy,the intraoperative blood loss was lower in the intervention group(571.3±100.3 ml vs.1020.4±267.9 ml,P<0.001),and the postoperative complication rate was lower[4.7%(6/127)vs.12.1%(13/107),P=0.038]and the tumor resection rate was higher[91.3%(116/127)vs.80.4%(86/107),P=0.015].Conclusions The neurointerventional technique seems safe and effective in the evaluation and treatment of RVT,which could decrease intraoperative blood loss,improve the rate of total resection and reduce related postoperative complications.