Onyx胶介入栓塞法与伽玛力治疗颅内动静脉畸形对照研究
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摘要
目的探讨Onyx胶介入栓塞法治疗颅内动静脉畸形(AVM)患者临床效果及术后近、中期预后。方法选取郑州大学附属南阳医院2014-04—2016-06收治的69例AVM患者,按照随机数字表法分组,对照组34例给予伽玛刀治疗,观察组35例予以Onyx胶介入栓塞法治疗,观察2组病灶治疗效果、病灶体积缩小情况、住院时间及改良Rankin评分,并统计2组并发症发生情况及生活质量(QOL)评分。结果观察组完全栓塞率为65.71%(23/35),高于对照组的26.47%(9/34),差异有统计学意义(P<0.05);观察组病灶体积缩小程度大于对照组,差异有统计学意义(P<0.05);术后3个月及1a观察组改良Rankin评分均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.71%(2/35),低于对照组的26.47%(9/34),差异有统计学意义(P<0.05);术后3个月观察组QOL评分高于对照组,差异有统计学意义(P<0.05)。结论 Onyx胶介入栓塞法可改善AVM患者神经功能,缩小病灶体积,提高生活质量,完全栓塞率高,并发症发生率低。
Objective To investigate the clinical effect of Onyx glue embolization in the treatment of arterovenous malformations(AVM)and its postoperative follow-up study in near and medium term.Methods From April 2014 to June 2016,selected69 patients with AVM in our hospital were randomly divided into control group(n=34)and observation group(n=35),the control group was treated with Gamma knife,and the observation group was treated with Onyx adhesion embolization.Lesion treatment,lesion size reduction,hospital stay,and improved Rankin score were observed and compared between the two groups.The incidence of complications and the quality of life(QOL)score were statistically analyzed.Results The total embolization rate was65.71%(23/35)in the observation group,which was higher than that in the control group(26.47%,9/34),the difference was statistically significant(P<0.05).The size of the lesion in the observation group was larger than that in the control group,the difference was statistically significant(P<0.05).The corrected Rankin score of the observation group was lower than that of the control group at 3 months and 1 year after operation,the difference was statistically significant(P<0.05).The incidence of complications in the observation group was 5.71%(2/35),which was lower than that in the control group(26.47%,9/34),the difference was statistically significant(P<0.05).The QOL score of the observation group was higher than that of the control group at3 months after operation,the difference was statistically significant(P<0.05).Conclusion Onyx adiplectic embolization can improve the neurological function,reduce the lesion volume,improve the quality of life in AVM patients with higher embolization rate and the lower incidence of complication.
Objective To investigate the clinical effect of Onyx glue embolization in the treatment of arterovenous malformations(AVM)and its postoperative follow-up study in near and medium term.Methods From April 2014 to June 2016,selected69 patients with AVM in our hospital were randomly divided into control group(n=34)and observation group(n=35),the control group was treated with Gamma knife,and the observation group was treated with Onyx adhesion embolization.Lesion treatment,lesion size reduction,hospital stay,and improved Rankin score were observed and compared between the two groups.The incidence of complications and the quality of life(QOL)score were statistically analyzed.Results The total embolization rate was65.71%(23/35)in the observation group,which was higher than that in the control group(26.47%,9/34),the difference was statistically significant(P<0.05).The size of the lesion in the observation group was larger than that in the control group,the difference was statistically significant(P<0.05).The corrected Rankin score of the observation group was lower than that of the control group at 3 months and 1 year after operation,the difference was statistically significant(P<0.05).The incidence of complications in the observation group was 5.71%(2/35),which was lower than that in the control group(26.47%,9/34),the difference was statistically significant(P<0.05).The QOL score of the observation group was higher than that of the control group at3 months after operation,the difference was statistically significant(P<0.05).Conclusion Onyx adiplectic embolization can improve the neurological function,reduce the lesion volume,improve the quality of life in AVM patients with higher embolization rate and the lower incidence of complication.
引文
[1]Mohr JP,Parides MK,Stapf C,et al.Medical management with or without interventional therapy for unruptured brain arteriovenous malformations(ARUBA):a multicentre,non-blinded,randomised trial[J].Lancet,2014,383(9917):614-621.
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[5]霍晓川,李佑祥,江裕华,等.Onyx胶栓塞结合伽玛刀治疗颅内动静脉畸形的疗效分析[J].中华神经外科杂志,2015,31(11):1 126-1 130.
[6]李小辉,冯正健,黄戈,等.Onyx胶栓塞治疗脑动静脉畸形35例临床分析[J].中国微侵袭神经外科杂志,2014,19(4):170-171.
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[8]周溱,周江,华赞,等.单纯Onyx胶栓塞治疗SMⅠ?Ⅳ级脑动静脉畸形疗效的比较[J].临床和实验医学杂志,2013,12(8):588-590.
[9]高旭,于春泳,李志清,等.弹簧圈近端辅助Onyx胶栓塞技术治疗脑动静脉畸形(附22例报告)[J].中华神经外科杂志,2014,30(3):221-224.
[10]Derdeyn CP,Zipfel GJ,Albuquerque FC,et al.Management of Brain Arteriovenous Malformations:A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2017,48(8):e200-e224.
[11]陈锦州,夏国强,银公敬,等.颅内动静脉畸形Onyx栓塞治疗并发脑出血临床分析[J].海南医学,2014,25(20):3 075-3 077.
[12]Bervini D,Morgan MK,Ritson EA,et al.Surgery for unruptured arteriovenous malformations of the brain is better than conservative management for selected cases:a prospective cohort study[J].J Neurosurg,2014,121(4):878-890.
[13]张龙,刘保国,李伟光,等.远距离注射Onyx胶介入栓塞联合伽玛刀治疗脑动静脉畸形[J].新医学,2015,46(11):748-752.
[14]杭军.Onyx胶介入栓塞与伽玛刀治疗脑动静脉畸形的效果对比研究[J].临床和实验医学杂志,2017,16(8):793-796.
[15]杨鹏,赵卫,沈进.Onyx胶治愈性栓塞脑动静脉畸形的临床研究[J].介入放射学杂志,2013,22(2):93-98.
[2]吕远,马建华,李晓兴.应用Onyx胶栓塞治疗脑动静脉畸形16例分析[J].中西医结合心脑血管病杂志,2013,11(3):381-383.
[3]赵平,汪雷,马金阳.Onyx胶栓塞颅内动静脉畸形的临床分析[J].中国临床神经外科杂志,2015,20(8):476-477.
[4]Nerva JD,Mantovani A,Barber J,et al.Treatment outcomes of unruptured arteriovenous malformations with a subgroup analysis of ARUBA(A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-eligible patients[J].Neurosurgery,2015,76(5):563-570.
[5]霍晓川,李佑祥,江裕华,等.Onyx胶栓塞结合伽玛刀治疗颅内动静脉畸形的疗效分析[J].中华神经外科杂志,2015,31(11):1 126-1 130.
[6]李小辉,冯正健,黄戈,等.Onyx胶栓塞治疗脑动静脉畸形35例临床分析[J].中国微侵袭神经外科杂志,2014,19(4):170-171.
[7]Kim H,Abla AA,Nelson J,et al.Validation of the supplemented Spetzler-Martin grading system for brain arteriovenous malformations in a multicenter cohort of1009surgical patients[J].Neurosurgery,2014,76(1):25-33.
[8]周溱,周江,华赞,等.单纯Onyx胶栓塞治疗SMⅠ?Ⅳ级脑动静脉畸形疗效的比较[J].临床和实验医学杂志,2013,12(8):588-590.
[9]高旭,于春泳,李志清,等.弹簧圈近端辅助Onyx胶栓塞技术治疗脑动静脉畸形(附22例报告)[J].中华神经外科杂志,2014,30(3):221-224.
[10]Derdeyn CP,Zipfel GJ,Albuquerque FC,et al.Management of Brain Arteriovenous Malformations:A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association[J].Stroke,2017,48(8):e200-e224.
[11]陈锦州,夏国强,银公敬,等.颅内动静脉畸形Onyx栓塞治疗并发脑出血临床分析[J].海南医学,2014,25(20):3 075-3 077.
[12]Bervini D,Morgan MK,Ritson EA,et al.Surgery for unruptured arteriovenous malformations of the brain is better than conservative management for selected cases:a prospective cohort study[J].J Neurosurg,2014,121(4):878-890.
[13]张龙,刘保国,李伟光,等.远距离注射Onyx胶介入栓塞联合伽玛刀治疗脑动静脉畸形[J].新医学,2015,46(11):748-752.
[14]杭军.Onyx胶介入栓塞与伽玛刀治疗脑动静脉畸形的效果对比研究[J].临床和实验医学杂志,2017,16(8):793-796.
[15]杨鹏,赵卫,沈进.Onyx胶治愈性栓塞脑动静脉畸形的临床研究[J].介入放射学杂志,2013,22(2):93-98.