坚持“三个首选”与“治疗原则”在创伤性颈内动脉海绵窦瘘诊治中的科学性与临床价值

Scientific and clinical value of"three first choices"and"treatment principles"in diagnosis and treatment of patients with traumatic internal carotid cavernous fistulas

目的探讨治疗创伤性颈内动脉海绵窦瘘(TCCF)坚持"三个首选"(首选血管内介入治疗、首选经颈内动脉入路、首选可脱球囊为栓塞材料)和"治疗原则"(闭塞瘘口、保留颈内动脉通畅、改善颅内循环、消除眼部症状)的科学性及实用性。方法回顾性分析2011年7月至2020年4月收治的41例TCCF的临床资料。通过动脉入路40例,联合动静脉通路1例;采用可脱球囊33例,应用覆膜支架10例,使用两种或以上材料8例;辅助弹簧圈填充残余瘘6例,辅助使用Onyx胶闭塞残余瘘2例;球囊闭塞试验证实后闭塞颈内动脉与瘘口5例。结果所有病人均治愈,无死亡,未因治疗增加残疾;一次介入治愈29例,二次介入治愈10例,三次介入治愈2例;瘘口完全闭塞36例,瘘口残留少量血流5例,经辅助间断性压迫颈动脉后治愈。结论本文结果进一步验证了"三首选"与"治疗原则"在TCCF诊治中的科学性与临床价值。

Objective To discuss the scientific and clinical value of treating traumatic internal carotid cavernous fistulas(TCCF)by adhering to the"three first choices"(the endovascular interventional therapy as the first choice of treatment method,the internal carotid artery approach as the first choice of treatment approach,the detachable balloon as the first choice of embolic material)and the treatment principles(to occlude the fistulas,to keep the internal carotid artery patency,to improve intracranial circulation,and to eliminate the ocular symptoms).Methods The clinical data of 41 patients with TCCF who were admitted to our hospital from July 2011 to April 2020 were analyzed retrospectively.Arterial approaches were used in 40 patents,and arterial approach combined with venous approach in 1 patient.Detachable balloons were used in 33 patients,covered-stents were in 10 patients,two or more materials were used in 8 patients.Coils were used to fill the residual fistulas in 6 patients,and Onyx glue was used in 2 patients.The internal carotid arteries and fistulas were occluded after balloon occlusion test in 5 patients.Results All the patients were cured,with no deaths and no disability due to the treatment.Twenty-nine patients were cured by one intervention,10 by two interventions,and 2 by three interventions.The fistulas were completely occluded in 36 patients,and left with a small amount of blood flow at the fistula in 5 who were healed by assisting intermittent compression of the carotid artery.Conclusions Our results further verify the scientific and clinical value of the"three first choices"and"treatment principles"in the diagnosis and treatment of patients with TCCF.