Xiang Yongjun,Wang Hangzhou,Yang Tianquan,et al.Staged surgery for supratentorial arteriovenous malformation rupture in children during acute phase[J].Journal of Clinical Pediatric Surgery,2023,22(09):881-884.[doi:10.3760/cma.j.cn101785-202207045-016]
儿童幕上脑动静脉畸形破裂出血急性期分阶段手术的疗效分析
- Title:
- Staged surgery for supratentorial arteriovenous malformation rupture in children during acute phase
- Keywords:
- Supratentorial arteriovenous malformation; Surgical Procedures; Operative; Microsurgical treatment; Child
- 摘要:
- 目的 初步探讨儿童幕上脑动静脉畸形(arteriovenous malformation,AVM)破裂出血急性期分阶段手术治疗方案,评估儿童AVM分阶段治疗的预后。方法 回顾性分析苏州大学附属儿童医院2015年1月至2018年12月经分阶段手术治疗的37例幕上AVM破裂出血患儿临床资料。收集患儿临床表现、手术方式以及预后情况并进行分析。结果 37例幕上AVM患儿均一期行急诊手术治疗,其中颅内血肿清除术27例,脑室外引流术10例,无一例死亡病例。病情平稳后行计算机断层血管造影(computed tomographic angiography,CTA)或数字减影血管造影(digital subtraction angiography,DSA)检查,并根据Spetzler-Martin评分分级,其中Ⅰ级12例、Ⅱ级16例、Ⅲ级9例。37例患儿均行AVM切除术,手术均在前次手术后2周左右进行。6个月后复查DSA无AVM残留及复发。格拉斯哥结局量表(Glasgow outcome scale,GOS)评分5分32例(32/37,86.5%),4分5例(5/37,13.5%)。随访6个月至4年,随访期间无一例再出血。结论 因某些特定条件不能完成术前脑血管成像时,对部分幕上AVM破裂出血急性期患儿采取分阶段手术治疗是可行的,能获得较好预后,较少遗留神经功能障碍。
- Abstract:
- Objective To explore the staged surgery for children with supratentorial arteriovenous malformation rupture and hemorrhage and evaluate the prognosis of staged treatment of arteriovenous malformation(AVM)in children.Methods From January 2015 to December 2018,retrospective analysis was conducted for clinical data of 37 children with supratentorial cerebral arteriovenous malformation hemorrhage undergoing staged surgery.Clinical manifestations,surgical approaches and follow-up outcomes were recorded.Results Emergency operation in the first stage was performed.There were intracranial hematoma evacuation(n=27)and extraventricular drainage(n=10).There was no mortality.After stabling,computed tomographic angiography(CTA)or digital subtraction angiography(DSA)was examined and the results were graded according to the Spetzler-Martin scheme.The grades were Ⅰ(n=12),Ⅱ(n=16)and Ⅲ(n=9).AVM resection was performed at Week 2 after an initial operation.DSA indicated that AVMs were completely removed at Month 6.Glasgow outcome scale(GOS)score at the end of follow-up was 5(n=32,86.5%)and 4(n=5,13.5%).No hemorrhage occurred during a follow-up period of(6-48)months.Conclusion When preoperative cerebrovascular imaging cannot be completed due to certain conditions,staged treatment of supratentorial cerebral arteriovenous malformation rupture during acute phase is a feasible option for achieving a better prognosis with less neurological dysfunction in children.
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备注/Memo
收稿日期:2022-7-25。
基金项目:苏州市姑苏区卫生人才计划(GSWS2020051)
通讯作者:王杭州,Email:wanghangzhoudr@126.com