颅内动静脉畸形合并近端动脉瘤多因素分析及治疗方式探讨

Multifactorial analysis and treatmentof intracranial arteriovenous malformation complicated with proximal aneurysm

目的:探讨脑动静脉畸形(AVM)并发供血动脉近端动脉瘤(APIA)的危险因素及其治疗方式。方法:回顾分析了352例AVM病人,按有无APIA,分为Non-APIA组(321例)和APIA组(31例),比较2组性别、年龄、AVM的血供和大小、引流静脉类型,是否出血及出血部位,并进行多因素分析。对于AVM合并APIA的病人根据不同的治疗方式分为血管内治疗组、手术治疗组及手术+血管内治疗组,对不同治疗方式供血动脉、动脉瘤最大径、AVM最大径、治疗后再出血率及GOS预后评分进行比较。结果:APIA组病人年龄高于Non-APIA组(P<0.01),后循环供血率51.6%(16/31)明显高于Non-APIA组的22.7%(73/321)(P<0.05)。多因素分析发现年龄大及AVM血供均为APIA发生的独立危险因素。血管内治疗、手术治疗、手术+血管内治疗3组病人动脉瘤的供血动脉、动脉瘤最大径、AVM最大径、术后再出血率及GOS预后评分差异均无统计学意义(P>0.05)。结论:年龄越大发生APIA的可能性越高,后循环供血的AVM越容易并发APIA,在优先处理动脉瘤的原则指导下,手术、血管内治疗以及手术+血管内治疗综合治疗均能取得较好的预后。

Objective:To investigate the risk factors of cerebral arteriovenous malformation(AVM)compolicated with proximal intracranial aneurysm(APIA)and its treatment.Methods:The clinical data of 352 patients with AVM were retrospectively analyzed,and the patents were divided into the non-APIA group(321 cases)and APIA group(31 cases)according to the presence or absence of APIA.The gender,age,blood supply and size of AVM,drainage vein type,bleeding and bleeding site were compared between two groups,and the multivariate analysis was conducted.The patients with AVM complicated with APIA were divided into the endovascular treatment group,surgery treatment group and surgery combined with endovascular treatment group according to different treatment methods.The blood supplying artery,maximum diameter of aneurysm,maximum dimeter of AVM,post-treatment rebleeding rate and GOS prognosis score were compared among three groups.Results:The age of patients in APIA group was higher than that in non-APIA group(P<0.01),and the rate of blood supply of posterior circulation in APIA group was 51.6%(16/31),which was significantly higher than that in non-APIA group(22.7%,73/321)(P<0.05).The results of multivariate analysis showed that the age and AVM blood supply were the independent risk factors of APIA.The differences of the aneurysm supplying artery,maximum diameter of aneurysm,maximum diameter of AVM,postoperative rebleeding rate and GOS prognosis score among endovascular treatment,surgery treatment and surgery combined with endovascular treatment groups were not statistically significant(P>0.05).Conclusions:The older the patient is,the more likely APIA will occur,and the AVM supplied by the posterior circulation is more likely to be complicated with APIA.Under the guidance of the principle of priority treatment of aneurysms,the surgery treatment,endovascular treatment and surgery combined with endovascular treatment can achieve a better prognosis.