术前不同栓塞方法辅助手术治疗富血运脑膜瘤效果分析

Comparative study of preoperative Onyx embolization using a method of distant control injection versus preoperative PVA embolization for hypervascular meningiomas.

目的探讨遥控注射Onyx及常规注射聚乙烯醇(polyvinyl alcohol,PVA)颗粒辅助手术治疗富血运脑膜瘤的效果。方法回顾性分析43例富血运脑膜瘤患者的临床资料。根据栓塞使用的材料分为Onyx栓塞组28例和PVA栓塞组15例。Onyx栓塞组术者在观察控制室采用遥控注射Onyx行选择性肿瘤供血动脉栓塞,PVA栓塞组术者在介入手术室使用PVA颗粒栓塞肿瘤供血动脉。栓塞术后3~5 d行开颅肿瘤切除术。分析肿瘤染色减少率,栓塞相关的肿瘤卒中等并发症发生率,开颅手术时间,术中出血量及肿瘤切除率等。结果Onyx栓塞组肿瘤染色减少率(64.93%±22.92%)较PVA栓塞组(50.02%±20.89%)高(P<0.05),PVA栓塞组发生肿瘤内出血1例。与PVA栓塞组比较,Onyx栓塞组开颅手术时间缩短(311.79 min±66.32 min vs.368.80 min±111.95 min,P<0.05),术中出血量较少(585.71 mL±125.36 mL vs.673.33 mL±138.70 mL,P<0.05),肿瘤切除率无统计学差异(99.10%±0.03%vs.94.98%±0.10%,P>0.05)。结论遥控注射Onyx辅助手术治疗富血运脑膜瘤较常规注射PVA减少肿瘤供血和术中出血,并能节省手术时间。

ObjectiveTo compare the surgical time and surgical bleeding between preoperative Onyx embolizationusing a method of distant control injection and preoperative PVA embolization in patients with hypervascular meningiomas.MethodsThe clinical data of 43 patients with hypervascular meningiomas were retrospectively collected and analyzed.Embolization was performed with Oynx using a method of distant control injection in 28 and with polyvinyl alcohol(PVA)particles in 15 patients. Preoperative embolization treated with Onyx was conducted in objective control room using amethod of distant control injection. Tumor removal performed 3~5 days after the embolization. Primary objective endpointswere reduction of tumor stain, incidence of complication, surgical time, resection grade and surgical bleeding.Results The reduction rate of tumor stain was significantly higher in patients treated with Onyx than in patients embolized withPVA(64.93%±22.92% vs. 50.02%±20.89%, P<0.05). Intratumoral bleeding occurred in one patient treated with PVA. Theoperative time was shorter in patients treated with Onyx than in those with PVA(311.79 min±66.32 min vs. 368.80 min±111.95 min, t=-2.103, P<0.05). The surgical bleeding was less in patients with Onyx than in those with PVA(585.71 mL±125.36 mL vs. 673.33 mL±138.70 mL,P<0.05). There was no significant difference in the resection rate between the twogroups(99.10%±0.03% vs. 94.98%±0.10%,P>0.05).ConclusionsPreoperative Onyx embolization using a method of distant control injection significantly minimizes the blood supply of tumor, reduces intraoperative blood loss and reducesoperative time compared with preoperative PVA embolization for hypervascular meningiomas.