李小辉　黄戈　冯正健　吴宇红　伍益　李智斌

[摘要] 目的 探究經动脉入路结合球囊辅助技术介入栓塞硬脑膜动静脉瘘（DAVFs）在技术上的安全性及疗效的确切性。 方法 选择广东省江门市中心医院2013年1月～2016年4月收治的22例DAVFs患者作为研究对象。根据病情和影像特征，将患者分为观察组（12例）和对照组（10例）。观察组包含8例经动脉入路和4例经静脉入路，均采用球囊辅助技术进行栓塞，对照组包含6例经动脉入路和4例经静脉入路，均单纯用Onyx胶栓塞方法。术后随访观测患者并发症情况和DAVFs的瘘口闭塞及复发情况。 结果 观察组和对照组各1例患者出现并发症。所有患者没有神经功能损伤、严重脑梗死等情况，生存率为100%。观察组12例全部栓塞，复发率为8.33%；对照组全部栓塞8例，1例次全栓塞，1例部分栓塞，复发率为20.00%。两组复发率比较，差异有统计学意义（P < 0.05）。 结论 经动脉入路结合球囊辅助技术Onyx胶栓塞硬脑膜动静脉瘘能够提高治愈率，值得临床推广应用。

[关键词] 动脉入路；静脉入路；硬脑膜动静脉瘘；球囊辅助技术；Onyx胶

[中图分类号] R651.12 [文献标识码] A [文章编号] 1673-7210（2016）12（a）-0055-04

Artery approach combined with balloon assistive technology Onyx glue occluding dural arteriovenous fistulas

LI Xiaohui1 HUANG Ge1 FENG Zhengjian1 WU Yuhong2 WU Yi1 LI Zhibin1

1.Department of Neurosurgery， the Central Hospital of Jiangmen， Guangdong Province， Jiangmen 529030， China； 2.Department of Cardiovascular， the Central Hospital of Jiangmen， Guangdong Province， Jiangmen 529030， China

[Abstract] Objective To explore the curative effect and security of occluding dural arteriovenous fistulas （DAVFs） via artery approach combine with the balloon assisted technique and Onyx glue. Methods From January 2013 to April 2016， a total of 22 patients with DAVFs in the Central Hospital of Jiangmen were selected. According to the illness and imaging characteristics， those patients were divided into the observation group （n=12） and the control group （n=10）. The patients in the observation group were occluded by balloon assisted technique， including 8 cases via artery approach and 4 cases via vein approach. The patients in the control group were only occluded by Onyx glue， including 6 cases via artery approach and 4 cases via vein approach. Complications， occlusion and relapse of the fistula after operation were observed by follow-up visit. Results 1 patient had complications in the observation group as well as 1 patient had complications in the control group. All of the patients had no neurologic injury and severe cerebral infarction. The survival rate was 100%. All 12 patients in the obsercotion group had complete embolism which had 8 cases in the control， another two patients had secondary complete embolism and partial embolism respectively in the control group. The recurrence rate of observation group was 8.33% and the recurrence rate of control group was 25.00%， the difference was statistically significant （P < 0.05）. Conclusion The artery approach combine with clinical balloon assistive technology Onyx glue can improve the cure rate of patients with DAVFs， which is worthy of clinical application.

[Key words] Artery approach； Vein approach； Dural arteriovenous fistula； Balloon assistive technology； Onyx glue

硬脑膜动静脉瘘（dural arteriovenous fistulas，DAVFs）是指发生在硬脑膜上的颅内血管畸形，占颅内血管畸形的10%～15%[1]，多见于成人，是临床上易漏诊、误诊的难治性脑血管疾病。DAVFs因素在颅内血管畸形造成颅内出血的因素中，高于5%[2]，每年死亡率达10.4%[3]。目前，介入血管内栓塞是治疗DAVFs的主要手段[4]，而Onyx胶是较为新型的一种液态栓塞剂，能够在血管沉淀后呈柔软的海绵状颗粒，其用于DAVFs的栓塞治疗的安全性及有效性已得到初步认可。本文探讨经动脉入路方式和经静脉入路方式，并分别结合球囊辅助栓塞技术和单纯Onyx胶栓塞技术的效果，为五邑地区的脑卒中防治提供一种新的方法。……