Glubran胶和Onyx胶栓塞治疗颅内小型动静脉畸形的临床研究

Clinical study of Glubran and Onyx glue embolization in the treatment of intracranial small arteriovenous malformation

目的探讨Glubran胶和Onyx胶栓塞治疗颅内小型动静脉畸形(arteriovenous malformation,AVM)的有效性和安全性。方法选择自2018年7月至2022年12月在某院住院治疗的小型AVM患者48例,使用Onyx18胶治疗的25例患者为Onyx组,采用33%浓度Glubran胶治疗的23例患者为Glubran组。治疗后观察统计患者完全栓塞率、围手术期并发症发生率及预后情况。结果围手术期并发症发生共10例,Onyx组6例(24.00%),Glubran组4例(17.39%),两组间并发症发生率未见明显差异(P=0.836);术后即刻造影可见Onyx组完全栓塞率64.00%(16/25),Glubran组完全栓塞78.26%(18/23),两组术后即刻栓塞率未见明显差异(P=0.278);术后6个月及1年复查DSA,Onyx组完全栓塞率分别为84.00%(21/25)、91.30%(21/23),Glubran组完全栓塞分别为78.26%(18/23)、100%(23/23),两组随访半年及1年栓塞率未见明显差异(P>0.05);术后6个月及1年症状改善率分别为65.79%(25/38)、77.78%(28/36)。结论Glubran胶和Onyx胶治疗小型AVM的有效性及安全性上无明显差异。两种胶均能明显改善患者临床症状,获得较好的临床疗效,而Glubran胶价格相对便宜、不具备毒性作用并且不依赖特定的输送微导管的特点。因此,对于刚开展AVM液体栓塞治疗的神经介入中心优先选择33%浓度Glubran胶。

Objective To investigate the efficacy and safety of Glubran and Onyx glue embolization in the treatment of intracranial small arteriovenous malformation(AVM).Methods Forty-eight patients with small AVM who were hospitalized in a hospital from July 2018 to December 2022 were selected.Twenty-five patients treated with Onyx18 glue were classified as the Onyx group,and twenty-three patients treated with 33%Glubran glue were classified as the Glubran group.The rate of complete embolization,the incidence of perioperative complications and the prognosis of the patients were observed and recorded after treatment.Results Perioperative complications were observed in a total of 10 patients,with 6 patients(24.00%)in the Onyx group and 4 patients(17.39%)in the Glubran group.There was no significant difference in the rate of complications between the two groups(P=0.836).Immediate postoperative angiography revealed complete embolization rates of 64.00%(16/25)in the Onyx group and 78.26%(18/23)in the Glubran group.There was no significant difference in the immediate embolization rate between the two groups(P=0.278).Digital subtraction angiography(DSA)was reexamined 6 months and 1 year after the operation.The complete embolization rate in the Onyx group was 84.00%(21/25)at 6 months and 91.30%(21/23)at 1 year.In the Glubran group,it was 78.26%(18/23)at 6 months and 100%(23/23)at 1 year.There was no significant difference in the embolization rate between the two groups after half a year and one year of follow-up(P>0.05).The symptom improvement rates at 6 months and 1 year after the operation were 65.79%(25/38)and 77.78%(28/36),respectively.Conclusion There is no significant difference in efficacy and safety between Glubran and Onyx glue in the treatment of small AVM.Both of them can significantly improve the clinical symptoms of patients and achieve good clinical efficacy.Glubran glue,being relatively inexpensive and devoid of toxic effects while not relying on specific microcatheters for delivery.Therefore,33%concentration of Glubran glue is preferred for the nerve intervention center that have recently initiated liquid embolization therapy for AVM.