摘要
目的回顾性分析2086例脑动静脉畸形(AVM)患者和1992年后经外科手术治疗的635例患者。对这些患者的临床特征和外科手术结果加以评估。方法对1956年1月至2001年10月2086例AVM患者数据收集分析。AVM的大小范围由1～9cm。经外科手术治疗的患者按入院时间分为2组:一组为1992年至1996年另一组由1997年至2001年。本组研究中,评估临床特征的变量包括:年龄、性别、Spetzler-Martin分级、首发症状。外科手术结果的评估是通过比较两手术组之间的手术并发症。结果脑AVM好发20～40岁,其中脑出血(43.4%),头痛(24.9%)和癫痫发作(17.3%)是首发常见的三种表现。两组间年龄分布和性别比率无差异。采用Spetzler-Martin分级系统,Ⅲ～Ⅴ级患者百分率增加,Ⅰ和Ⅱ级患者百分率下降。但主要外科手术并发症的发生率(死亡,偏瘫,颅神经功能障碍和胃肠出血)无显著性差异(P=0.796)。结论脑AVM是青年患者自发性颅内出血的重要原因之一。Spetzler-Martin分级对预测手术风险有帮助。显微外科手术技术使手术治疗更加安全,并成为脑AVM患者的最佳选择。在治疗巨大脑AVM时,术中栓塞后手术切除是切实可行的治疗方法。
Objective A series of 2086 patients with cerebral arteriovenous malformations (AVMs) were reviewed and 635 patients underwent surgical treatment after 1992. Clinical characteristics and surgical results of patients with cerebral arteriovenous malformations (AVMs) were assessed. Mesthod Collected data of 2086 consecutive AVM patients from January 1956 to October 2001 were analyzed. The size of the AVMs ranged from 1 cm to 9 cm. Patients underwent surgical treatment were divided into two groups by date of admission: Group Ⅰ was from 1992 to 1996 and Group Ⅱ was from 1997 to 2001. The clinical characteristics such as: age (at diagnosis), sex, Spetzler-Martin grade and first presentations were assessed: The surgical results were assessed by compared the surgical complications between the two groups. Results Cerebral AVMs were more commonly diagnosed at age of 20 to 40 years. Hemorrhage (43.4%), headache (24.9%) and seizure (17.3%) were the first three common presentations. There was no difference in age distribution and sex ratio between the two groups. Regarding Spetzler-Martin grading system, the percentage of grade Ⅲ to Ⅴ patients increased while that of grade Ⅰ and Ⅱ patients decreased. But the incidence of major surgical complications (death, hemiparalysis, cranial nerve dysfunction and gastrointestinal hemorrhage) was the same (P=0.796). Conclusions Cerebral AVM is one of the important reasons for the spontaneous intracranial hemorrhage in young patients. Spetzler-Martin grading system is helpful to predict the surgical risk. Microsurgical technique has made surgical treatment safer and become the best choice for cerebral AVM patients. Combination of intraoperative embolisation with surgical resection is a practical method in treatment of giant cerebral AVMs.
出处
《中华神经外科杂志》
CSCD
北大核心
2004年第2期113-117,共5页
Chinese Journal of Neurosurgery
关键词
脑动静脉畸形
临床特征
治疗
外科手术
Cerebral arteriovenous malformation
Clinical characteristics
Surgical risk
Giant
Cerebral arteriovenous malformation
