介入栓塞聯合血腫穿刺抽吸治療腦動靜脈畸形破裂合并血腫的療效分析

【摘要】 目的 探討微創手術在腦動靜脈畸形（AVM）破裂出血患者治療的應用價值。方法 選取2021年1月—2023年12月興義市人民醫院收治的56例腦AVM破裂出血患者作為研究對象，按照隨機數字表法分為實驗組與對照組各28例。實驗組微創手術采取介入栓塞聯合血腫穿刺手術治療，對照組采取常規開顱AVM切除及開顱血腫清除術治療。比較兩組不同手術治療方式后的療效差異。結果 "實驗組腦AVM畸形血管團體積減少率高于對照組、術中出血量少于對照組、血腫清除率高于對照組（P＜0.05）；實驗組的并發癥的發生率均明顯低于對照組（Plt;0.05）；實驗組出院時改良Rankin量表（mRS）評分和療效均優于對照組（P＜0.05）。結論 現代微創手術治療腦AVM破裂出血患者的療效較好、手術創傷較小、并發癥少、術后恢復較快，值得臨床推廣。

【關鍵詞】 微創手術；腦動靜脈畸形；出血；療效

【中圖分類號】 R743" 【文獻標志碼】 B" 【文章編號】 1672-7770（2025）01-0088-06

Efficacy analysis of interventional embolization combined with hematoma puncture and aspiration in the treatment of brain arteriovenous malformation rupture with hematoma

Abstract：" Objective To explore the application value of minimally invasive surgery in the treatment of patients with ruptured brain arteriovenous malformations（AVMs） and hemorrhage. Methods A total of 56 patients with ruptured cerebral AVMs， admitted to Xingyi People’s Hospital from January 2021 to December 2023， were selected for this study. According to a random number table method， the patients were divided into an experimental group and a control group， with 28 cases in each group. The experimental group underwent minimally invasive surgery with interventional embolization combined with hematoma puncture， while the control group received conventional craniotomy for AVM resection and craniotomy for hematoma evacuation. The efficacy of the different surgical treatments was compared between the two groups." Results The experimental group had a higher reduction rate of AVM vascular volume， less intraoperative blood loss， and a higher hematoma clearance rate compared to the control group（Plt;0.05）. The incidence of complications in the experimental group was significantly lower than in the control group（Plt;0.05）. The modified Rankin scale（mRS） score and therapeutic efficacy at discharge were significantly better in the experimental group than in the control group（Plt;0.05）." Conclusions Modern minimally invasive surgery for patients with ruptured cerebral AVMs demonstrates better efficacy， less surgical trauma， fewer complications， and faster postoperative recovery， making it worthy of clinical promotion.

Key words： minimally invasive surgery; cerebral arteriovenous malformation; hemorrhage; efficacy

腦動靜脈畸形（anteriovenous malformations，AVM）是最常見的腦血管疾病，主要的臨床表現為出血、癲癇、頭痛和神經功能障礙，破裂出血較多的患者因顱內出血破壞神經功能及引起顱內壓增高，保守治療無效，必須積極進行手術治療，以挽救患者生命［1］。目前腦AVM破裂出血患者的治療方法主要有血管內介入栓塞術、開顱顯微外科切除術、伽瑪刀立體定向放射治療以及聯合治療等，如何更好地治療破裂的畸形血管團及腦內血腫，一直是臨床醫生關注的問題。隨著介入手術、血腫穿刺手術的發展和技術的提高，以其創傷小、風險低、恢復快為特點，對于腦AVM破裂出血患者，越來越多的醫師和患者首選微創手術治療［2］。……