[1]孙荣辉　赵曰圆　秦　杰　黄　河　潘　力　杨　铭　宋　健　徐国政　姚国杰　马廉亭.坚持“三个首选”与“治疗原则”在创伤性颈内动脉海绵窦瘘诊治中的科学性与临床价值[J].中国临床神经外科杂志,2020,(09):577-580.[doi:10.13798/j.issn.1009-153X.2020.09.001]
　SUN Rong-hui,ZHAO Yue-yuan,QIN Jie,et al.Scientific and clinical value of "three first choices" and "treatment principles" in diagnosis and treatment of patients with traumatic internal carotid cavernous fistulas[J].,2020,(09):577-580.[doi:10.13798/j.issn.1009-153X.2020.09.001]
点击复制

坚持“三个首选”与“治疗原则”在创伤性颈内动脉海绵窦瘘诊治中的科学性与临床价值()
分享到：

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年09期
页码:
577-580
栏目:
论著
出版日期:
2020-09-20

文章信息/Info

Title:
Scientific and clinical value of "three first choices" and "treatment principles" in diagnosis and treatment of patients with traumatic internal carotid cavernous fistulas
文章编号:
1009-153X（2020）09-0577-04
作者:
孙荣辉　赵曰圆　秦　杰　黄　河　潘　力　杨　铭　宋　健　徐国政　姚国杰　马廉亭
430070 武汉，中国人民解放军中部战区总医院神经外科、中国人民解放军神经外科研究所、国家级重点学科神经外科（孙荣辉、赵曰圆、秦　杰、黄　河、潘　力、杨　铭、宋　健、徐国政、姚国杰、马廉亭）
Author(s):
SUN Rong-hui;  ZHAO Yue-yuan;  QIN Jie;  HUANG He;  PAN Li;  YANG Ming;  SONG Jian;  XU Guo-zheng;  YAO Guo-jie;  MA Lian-ting.
Department of Neurosurgery, General Hospital of Central Theater Command, PLA, Wuhan 430070, China
关键词:
创伤性颈内动脉海绵窦瘘; 血管内治疗; 动脉入路; 球囊
Keywords:
Traumatic internal carotid cavernous fistula;  Endovascular treatment;  Transarterial approach;  Detachable balloon
分类号:
A
DOI:
10.13798/j.issn.1009-153X.2020.09.001
文献标志码:
R 743; R 651.1+2
摘要:
目的 探讨治疗创伤性颈内动脉海绵窦瘘（TCCF）坚持“三个首选”（首选血管内介入治疗、首选经颈内动脉入路、首选可脱球囊为栓塞材料）和“治疗原则”（闭塞瘘口、保留颈内动脉通畅、改善颅内循环、消除眼部症状）的科学性及实用性。方法 回顾性分析2011年7月至2020年4月收治的41例TCCF的临床资料。通过动脉入路40例，联合动静脉通路1例；采用可脱球囊33例，应用覆膜支架10例，使用两种或以上材料8例；辅助弹簧圈填充残余瘘6例，辅助使用Onyx胶闭塞残余瘘2例；球囊闭塞试验证实后闭塞颈内动脉与瘘口5例。结果 所有病人均治愈，无死亡，未因治疗增加残疾；一次介入治愈29例，二次介入治愈10例，三次介入治愈2例；瘘口完全闭塞36例，瘘口残留少量血流5例，经辅助间断性压迫颈动脉后治愈。结论 本文结果进一步验证了“三首选”与“治疗原则”在TCCF诊治中的科学性与临床价值
Abstract:
Objective To discuss the scientific and clinical value of treating traumatic internal carotid cavernous fistulas(TCCF) by adhering to the "three first choices" (the endovascular interventional therapy as the first choice of treatment method, the internal carotid artery approach as the first choice of treatment approach, the detachable balloon as the first choice of embolic material) and the treatment principles (to occlude the fistulas, to keep the internal carotid artery patency, to improve intracranial circulation, and to eliminate the ocular symptoms). Methods The clinical data of 41 patients with TCCF who were admitted to our hospital from July 2011 to April 2020 were analyzed retrospectively. Arterial approaches were used in 40 patents, and arterial approach combined with venous approach in 1 patient. Detachable balloons were used in 33 patients, covered-stents were in 10 patients, two or more materials were used in 8 patients. Coils were used to fill the residual fistulas in 6 patients, and Onyx glue was used in 2 patients. The internal carotid arteries and fistulas were occluded after balloon occlusion test in 5 patients. Results All the patients were cured, with no deaths and no disability due to the treatment. Twenty-nine patients were cured by one intervention, 10 by two interventions, and 2 by three interventions. The fistulas were completely occluded in 36 patients, and left with a small amount of blood flow at the fistula in 5 who were healed by assisting intermittent compression of the carotid artery. Conclusions Our results further verify the scientific and clinical value of the "three first choices" and "treatment principles" in the diagnosis and treatment of patients with TCCF

参考文献/References:

[1] 马廉亭. 外伤性颈动脉海绵窦瘘诊治的整体策略[J]. 中国 临床神经外科杂志，2006，11（11）：641-642.
[2] Gemmete JJ, Ansari SA, Gandhi DM. Endovascular techni- ques for treatment of carotid-cavernous fistula [J]. J Neuro- ophthalmol, 2009, 29(1): 62-71.
[3] Gonzalez LF, Chalouhi N, Tjoumakaris S, et al. Treatment of carotid-cavernous fistulas using intraarterial balloon assis- tance: case series and technical note [J]. Neurosurg Focus, 2012, 32(5): E14.
[4] Gomez F, Escobar W, Gomez AM, et al. Treatment of carotid cavernous fistulas using covered stents: midterm results in seven patients [J]. AJNR Am J Neuroradiol, 2007, 28(9): 1762-1768.
[5] Morón FE, Klucznik RP, Mawad ME, et al. Endovascular treatment of high-flow carotid cavernous fistulas by stent- assisted coil placement [J]. AJNR Am J Neuroradiol, 2005, 26(6): 1399-1404.
[6] Zaidat OO, Lazzaro MA, Niu T, et al. Multimodal endovas- cular therapy of traumatic and spontaneous carotid caver- nous fistula using coils, n-BCA, Onyx and stent graft [J]. J Neurointerv Surg, 2011, 3(3): 255-262.
[7] 马廉亭. “放风筝”法治疗颈内动脉-海绵窦瘘[J]. 中华外 科杂志，1981，21（10）：618-620.
[8] 马廉亭. 外伤性颈动脉海绵窦瘘诊断与血管内介入治疗 必需遵循的基本原则[J]. 临床外科杂志，2015，23（6）： 405-406.
[9] Yang M, Wu J, Ma LT, et al. The value of syngo dynaPBV neuro during neuro-interventional hypotensive balloon occlusion test [J]. Clin Neuroradiol, 2015, 25(4): 387-395.

相似文献/References:

[1]刘福德　邓剑平　张　涛　陈　虎　李　帅　王俭博　曲友直　赵振伟.椎-基底动脉夹层动脉瘤的血管内治疗（附48例分析）[J].中国临床神经外科杂志,2016,(06):353.[doi:10.13798/j.issn.1009-153X.2016.06.011]
　LIU Fu-de,DENG Jian-ping,ZHANG Tao,et al.Endovascular treatment of vertebrobasilar artery dissecting aneurysms (report of 48 cases)[J].,2016,(09):353.[doi:10.13798/j.issn.1009-153X.2016.06.011]
[2]潘　力　刘　鹏　秦　杰　杨　柳　安学峰　吴　虓　杨　铭　徐国政　马廉亭.Y型支架辅助技术在颅内动脉分叉部宽颈动脉瘤治疗中的应用[J].中国临床神经外科杂志,2016,(07):394.[doi:10.13798/j.issn.1009-153X.2016.07.002]
　PAN Li,LIU Peng,QIN Jie,et al.Application of Y -configuration stent technique to treatment of intracranial wide-neck bifurcation aneurysms[J].,2016,(09):394.[doi:10.13798/j.issn.1009-153X.2016.07.002]
[3]李玉龙　方兴根　李真保　吴德刚　赖年升　赵心同　徐善水　狄广福.血管内治疗颈内动脉床突旁破裂动脉瘤[J].中国临床神经外科杂志,2016,(02):79.[doi:10.13798/j.issn.1009-153X.2016.02.006]
　LI Yu-long,FANG Xing-gen,LI Zhen-bao,et al.Endovascular embolization of ruptured paraclinoid aneurysms (report of 26 cases)[J].,2016,(09):79.[doi:10.13798/j.issn.1009-153X.2016.02.006]
[4]廖驭国　刘胜初　钟云天　罗　捷.腰大池引流术防治颅内动脉瘤栓塞术后脑血管痉挛的临床疗效[J].中国临床神经外科杂志,2016,(02):89.[doi:10.13798/j.issn.1009-153X.2016.02.010]
　LIAO Yu-guo,LIU Sheng-chu,CHU Yun-tian,et al.Effect of lumbar cistern drainage on cerebral vasospasm in patients with ruptured intracranial aneurysms after embolization[J].,2016,(09):89.[doi:10.13798/j.issn.1009-153X.2016.02.010]
[5]张振海　沈春森　吴中学　杨新健　穆士卿.颅内巨大动脉瘤的血管内治疗分析[J].中国临床神经外科杂志,2015,(08):469.[doi:10.13798/j.issn.1009-153X.2015.08.008]
　ZHANG Zhen-hai,WU Zhong-xue,MU Shi-qing,et al.Endovascular treatment of giant intracranial aneurysms[J].,2015,(09):469.[doi:10.13798/j.issn.1009-153X.2015.08.008]
[6]胡北泉　阮玉山　魏　风　杨　松　廖光查　刘海峰　兰　杰　肖绍文.血管内栓塞治疗颅内宽颈动脉瘤46例分析[J].中国临床神经外科杂志,2015,(08):492.[doi:10.13798/j.issn.1009-153X.2015.08.018]
[7]廖旭兴　 蔡　瑜　王　辉　梁学军　段成斌　胡建军　邓其峻　马廉亭.小脑后下动脉动脉瘤的血管内治疗与手术治疗（附21例报道）[J].中国临床神经外科杂志,2015,(06):329.[doi:10.13798/j.issn.1009-153X.2015.06.003]
　LIAO Xu-xing,CAI Yu,WANG Hui,et al.Endovascular embolization and microsurgery of posterior inferior cerebellar artery aneurysms (report of 21 cases)[J].,2015,(09):329.[doi:10.13798/j.issn.1009-153X.2015.06.003]
[8]邹志鹏　杨　海　夏军勇　张化明　张　华　魏　恒　马江红.行血管内治疗的高龄颅内动脉瘤患者脑血管痉挛的临床分析[J].中国临床神经外科杂志,2015,(07):401.[doi:10.13798/j.issn.1009-153X.2015.07.006]
　ZOU Zhi-peng,YANG Hai,XIA Jun-yong,et al.Clinical analysis of symptomatic cerebral vasospasm after endovascular treatment of ruptured cerebral aneurysms in patients of 70 and over 70 years[J].,2015,(09):401.[doi:10.13798/j.issn.1009-153X.2015.07.006]
[9]周　洁.三维成篮技术结合水膨胀弹簧圈治疗颈动脉海绵窦瘘围手术期护理[J].中国临床神经外科杂志,2015,(09):567.[doi:10.13798/j.issn.1009-153X.2015.09.022]
[10]陈军辉 综述　王玉海 审校.颅内动脉瘤的治疗进展[J].中国临床神经外科杂志,2015,(04):252.[doi:10.13798/j.issn.1009-153X.2015.04.023]
[11]李亚兰　华　莎　马廉亭.创伤性颈内动脉海绵窦瘘血管内治疗围手术期的护理[J].中国临床神经外科杂志,2020,(12):879.[doi:10.13798/j.issn.1009-153X.2020.12.023]
[12]黄　昊　刘　坤　周　丹等.介入治疗创伤性颈内动脉海绵窦瘘39例[J].中国临床神经外科杂志,2021,26(03):193.[doi:10.13798/j.issn.1009-153X.2021.03.017]

备注/Memo

备注/Memo:
（2020-07-29收稿，2020-08-10修回）
更新日期/Last Update: 2020-09-20