摘要
目的总结和探讨复合手术在脊髓血管病外科治疗中的技术特点及疗效评价。方法回顾性分析2018年1月至2019年12月南京大学医学院附属鼓楼医院神经外科在复合手术室连续完成复合手术治疗的17例脊髓血管病患者的临床资料,其中硬脊膜动静脉瘘(SDAVF)12例,髓周动静脉瘘3例,脊髓动静脉畸形2例。首先使用DSA标记定位技术精准获得病变位置及设计手术切口,术中吲哚菁绿造影定位并动态显示病变情况,并通过手术前后DSA的对比以验证瘘口或畸形团切除的准确性。术后及随访时采用改良Aminoff-Logue残疾评分、脊髓损伤水平分级评估患者的脊髓功能改善情况(好转、无改善、恶化)。结果所有患者复合手术顺利完成,无误切或残留。1例SDAVF患者术前脊髓造影提示高流量瘘,术中定位切除瘘口后即时造影发现另一瘘口,扩大骨窗范围,重新定位后顺利切除。其余患者均一次性切除瘘口或畸形团,术中即时DSA示病变无显影。17例患者出院时相较术前,10例患者下肢肌力及感觉障碍有不同程度的改善,3例术前已存在括约肌功能障碍的患者术后恢复不明显。术后随访12个月,所有患者无复发,17例患者中有16例脊髓功能障碍明显好转。结论复合手术是外科治疗脊髓血管畸形的新的有效方法,相较于传统手术方式更精准、更安全,可避免残留及误损正常血供,有利于改善患者预后。
Objective To explore and summarize the technical features and effectiveness of hybrid operation in the surgical treatment of spinal cord vascular diseases.Methods A retrospective analysis was performed of the clinical data of 17 patients with spinal cord vascular diseases and who received hybrid operation at the Department of Neurosurgery Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2018 to December 2019.Among the 17 patients,12 patients had spine dural arteriovenous fistula(SDAVF),3 patients had perimedullary arteriovenous fistula,and 2 patients had spinal arteriovenous malformation(AVM).The location and skin incision of the lesion were accurately obtained using DSA in all patients.Indocyanine green angiography was used in operation and dynamically showed the lesion.The accuracy of the resection was verified by DSA before and after operation.The prognosis and follow-up of patients were evaluated by modified Aminoff-Logue disability score and American Spinal Injury Association grade for assessing improvement in spinal cord function(improved,not improved,worse)following hybrid operation.Results All hybrid operations were completed,and there was no accident or lesion remaining.One case with SDAVF showed high flow fistula on preoperative myeloangiography and an undetected fistula was located by real-time angiography after the resection of the preoperatively located one.Then the resection area was relocated to deal with the fistula detected in the operation and no lesion was found on the second real-time angiography.All other patients received one-time resection of fistula or AVM and real-time angiography was negative.Compared with preoperative status,10 out of 17 patients had improvement of muscle strength and sensation of lower limbs to varying degrees.Three patients with sphincter dysfunction before surgery had no obvious postoperative recovery.All patients were followed up for 12 months and their conditions were stable.Sixteen of the 17 patients with neurological dysfunction showed significant improvement in spinal cord dysfunction.Conclusions Hybrid operation is a new alternative treatment for spinal cord vascular malformation with more safety and accuracy compared with traditional surgical treatments.It can avoid residual lesion or damage of normal blood supply,so that being beneficial to improve the prognosis of patients.
作者
戴嵬
孙园园
王娟
吴凌云
李伟
王毅
杨咏波
刘涛
那世杰
张庆荣
杭春华
Dai Wei;Sun Yuanyuan;Wang Juan;Wu Lingyun;Li Wei;Wang Yi;Yang Yongbo;Liu Tao;Na Shijie;Zhang Qingrong;Hang Chunhua(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Institute of Neurosurgery,Nanjing University,Nanjing 210008,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2021年第10期704-712,共9页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金资助项目(81801166)。
关键词
硬脊膜动静脉瘘
髓周动静脉瘘
脊髓动静脉畸形
复合手术
Spinal dural arteriovenous fistula
Perimedullary arteriovenous fistula
Spinal arteriovenous malformation
Hybrid operation