【摘要】 目的总结胸段硬脊膜动静脉瘘的DSA诊断经验及手术治疗体会。方法选取近5年我院经脊髓数字减影血管造影(DSA)确诊的胸段硬脊膜动静脉瘘(SDAVF)24例,回顾性分析其临床及随访资料。结果本组患者分别经全椎板入路(4例)及半椎板入路(20例),紧靠硬脊膜下电凝并切断瘘结构向脊髓表面的引流静脉,术后予以扩容、血液稀释、改善循环、减轻水肿等药物治疗,24例患者均于刀口拆线后复查造影,证实脊髓表面引流静脉未再显影,术后3个月脊髓MRI检查及6~18个月随访,大部分患者脊髓表面静脉流空影消失,水肿减退,临床症状明显改善。结论胸段硬脊膜动静脉瘘临床症状多变,查体定位不准确,需根据脊髓MRI发现异常,并行脊髓DSA确诊,瘘口多偏于一侧,经半椎板入路多可显露并切断引流静脉,是治疗本病的首选方法,早期明确诊断、准确定位并行手术治疗,是预后的关键。更多还原

【Abstract】 Objective DSA diagnosis and treatment of thoracic spinal dural arteriovenous fistula are analyzed.Methods The clinical and follow-up data of 24 cases of thoracic spinal dural arteriovenous fistula( SDAVF) which were confirmed by spinal cord digital subtraction angiography( DSA) in recent 5 years were analyzed retrospectively.Results All the patients were treated by laminectomy approach( 4 cases) and hemilaminectomy approach( 20 cases). The spinal subdural electrocoagulation was performed and fistula structure close to the venous drainage of spinal cord surface was cut. After operation,expansion,hemodilution and the proper drug treatment were used. Re-check DSA of 24 patients confirmed no developing in the surface of the spinal cord venous drainage. In spinal MRI examination in 3 months after operation and during 6 ~18 months’ follow-up,the spinal cord surface venous flow void was disappeared,edema was decreased,and clinical symptoms were improved significantly in most patients.Conclusion The clinical symptoms of thoracic spinal dural arteriovenous fistula are various and physical examination is not accurate. The spinal cord MRI is suggested for detecting the abnormality and DSA of spinal cord is used for diagnosis. The fistula is located at one side. Exposure and cutting off the venous drainage by the hemilaminectomy approach is the preferred method for the disease. Early diagnosis,accurate positioning and surgery treatment are the keys for a good prognosis.更多还原