论文部分内容阅读
目的探讨影响硬脑膜动静脉瘘(dural arteriovenous fistula,DAVF)治疗后预后不良的危险因素。方法回顾性分析我中心近6年治疗的153例DAVF病例,收集患者临床表现、血管构筑学特征、治疗方式、影像学治疗结果和临床预后等资料,进行Kaplan-Meier估计和Cox回归分析。结果 153例患者平均随访(38.1±16.3)个月,近期随访改良Rankin评分(mRS)3～6级共21例,除术后并发症死亡的4例外,随访中死亡8例,另9例表现为神经功能缺损。Kaplan-Meier分析提示术前mRS≥3级、存在静脉窦血栓、经动静脉联合入路栓塞、术后影像学结果为部分栓塞或部分栓塞并皮质静脉引流(cortical venous reflux,CVR)、术后主窦不畅的患者有预后不良的趋势。Cox回归分析提示预后不良的危险因素包括:术前mRS≥3级(P=0.018)、术后影像学结果为部分栓塞并CVR(P=0.001)及术后主窦不畅(P=0.0001)。结论术前神经功能残损较重、术后影像学结果为部分栓塞合并CVR以及术后主窦不畅是DAVF患者治疗后预后不良的独立危险因素。
Objective To investigate the risk factors of poor prognosis after dural arteriovenous fistula (DAVF) treatment. Methods A retrospective analysis of 153 cases of DAVF treated in our center during the past 6 years was conducted. Kaplan-Meier estimates and Cox regression analysis were performed on clinical manifestations, vascular architecture, treatment modalities, imaging findings and clinical outcomes. Results A total of 153 patients were followed up for an average of (38.1 ± 16.3) months. In the recent follow-up, there were 21 patients with grade 3 to 6 improved Rankin score (mRS). Except for 4 patients with postoperative complications, 8 patients died and 8 patients were followed up For neurological deficits. Kaplan-Meier analysis suggested preoperative mRS≥3, presence of venous sinus thrombosis, arterial-venous thrombolysis, postoperative embolization or partial embolization and cortical venous reflux (CVR) Patients with poor sinus outcomes have a poor prognosis. Cox regression analysis showed that the risk factors for poor prognosis included preoperative mRS≥3 (P = 0.018), partial postoperative embolism with CVR (P = 0.001), and poor postoperative primary sinus (P = 0.0001) . Conclusions Preoperative neurological deficits were severe. Postoperative radiologic findings of partial embolization combined with CVR and poor postoperative sinus were independent risk factors for poor prognosis in patients with DAVF.