切换至 "中华医学电子期刊资源库"

中华介入放射学电子杂志 ›› 2020, Vol. 08 ›› Issue (03) : 199 -204. doi: 10.3877/cma.j.issn.2095-5782.2020.03.002

所属专题: 文献

专题研究·眼科介入

以突眼为表现的眼部血管病——颈动脉海绵窦瘘的介入治疗
王铭义1, 刘永晟1, 李克1, 刘勇建1, 张国栋1, 安祥博1, 吴邯1, 王峰1,()   
  1. 1. 116011 辽宁大连,大连医科大学附属第一医院介入治疗科
  • 收稿日期:2020-05-22 出版日期:2020-08-25
  • 通信作者: 王峰

Interventional treatment of carotid cavernous fistula with ocular vascular disease manifested by exophthalmos

Mingyi Wang1, Yongsheng Liu1, Ke Li1, Yongjian Liu1, Guodong Zhang1, Xiangbo An1, Han Wu1, Feng Wang1,()   

  1. 1. Department of Interventional Therapy, the First Affiliated Hospital of Dalian Medical University, Liaoning Dalian 116011, China
  • Received:2020-05-22 Published:2020-08-25
  • Corresponding author: Feng Wang
  • About author:
    Corresponding author: Wang Feng, Email:
引用本文:

王铭义, 刘永晟, 李克, 刘勇建, 张国栋, 安祥博, 吴邯, 王峰. 以突眼为表现的眼部血管病——颈动脉海绵窦瘘的介入治疗[J]. 中华介入放射学电子杂志, 2020, 08(03): 199-204.

Mingyi Wang, Yongsheng Liu, Ke Li, Yongjian Liu, Guodong Zhang, Xiangbo An, Han Wu, Feng Wang. Interventional treatment of carotid cavernous fistula with ocular vascular disease manifested by exophthalmos[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2020, 08(03): 199-204.

目的

探讨颈动脉海绵窦瘘眼部表现特点、影像学检查及介入治疗方法。

方法

回顾分析5年中18例首诊于我院眼科的颈动脉海绵窦瘘者的眼部症状及体征、影像学检查、治疗方法等。18例患者均行介入手术治疗,其中应用可解脱球囊封堵瘘口12例,应用弹簧圈+Onyx胶封堵瘘口3例,覆膜支架隔绝瘘口3例。

结果

所有病例中最常见的眼部表现为搏动性眼球突出、球结膜充血水肿、眼球运动障碍等。头颅或眼部CT平扫检查所有病例均显示患侧眼球突出,眼上静脉增粗;全部患者均行数字减影血管造影检查明确诊断。本组18例(20眼)均行介入手术治疗,其中应用可解脱球囊封堵瘘口12例(14眼),结果10例(12眼)瘘口完全闭塞,发生并发症2例,无严重并发症或死亡病例。应用弹簧圈+Onyx胶封堵瘘口3例(3眼)、覆膜支架隔绝瘘口3例(3眼),瘘口均完全闭塞,无并发症或死亡病例。全部手术患者眼部症状和体征均得到明显改善。随访时间(12±3.4)个月,无复发病例,颈动脉覆膜支架内未发生狭窄及闭塞。

结论

对于以突眼及其他相关症状就诊于眼科的患者,应考虑颈动脉海绵窦瘘的可能,血管造影是该病诊断的金标准,介入手术治疗对颈动脉海绵窦瘘是安全有效的。

Objective

To explore the ocular manifestations, imaging examination and interventional treatment of carotid cavernous fistula.

Methods

Retrospective analysis of the ocular symptoms and signs, imaging examinations, and treatment methods of 18 cases of carotid cavernous fistula who were first diagnosed in our hospital in 5 years was performed. All 18 patients underwent interventional treatment. Among them, 12 cases were sealed with detachable balloons, 3 cases were sealed with coils and Onyx, and 3 cases were covered with stent graft.

Results

The most common ocular manifestations in all cases were pulsatile eyeball protrusion, conjunctival congestion and edema, and eye movement disorders. All CT scans of the head or eyes showed that the eyeballs were protruded and the superior ocular veins were enlarged; all patients underwent digital subtraction angiography to confirm the diagnosis. All 18 cases (20 eyes) in this group underwent interventional treatment. Among them, 12 cases (14 eyes) were sealed with a detachable balloons to seal the fistula. As a result, 10 cases (12 eyes) were completely occluded, and 2 cases had complications, There were no serious complications or deaths. 3 cases(3 eyes) of fistula were sealed with coils & Onyx , and 3 cases (3 eyes) were isolated with stent graft. The fistula was completely occluded without complications or deaths. The ocular symptoms and signs of all patients were significantly improved. During the follow-up period (12±3.4 months), there was no recurrence, and no stenosis and occlusion occurred in the carotid stent graft.

Conclusions

For patients with exophthalmos and other related symptoms in ophthalmology, the possibility of carotid cavernous fistula should be considered. Angiography is the gold standard for the diagnosis of the disease. Interventional treatment is safe and effective for carotid cavernous fistula

表1 CCF患者眼部症状和体征
图1 颈动脉海绵窦瘘患者(男性,54岁,因头外伤6个月,左侧搏动性突眼1个月入院)的手术前后造影及体征图像
表2 治疗及随访
[1]
Gupta R, Horowitz M, Tayal A, et al. Denovo development of a remote arteriovenous fistula following transarterial embolization of a carotid cavernous fistula[J]. AJNR, 2005, 26: 2587-2590.
[2]
Van Rooij WJ, Sluzewski M, Beute GN. Ruptured cavernous sinus aneurysms causing carotid cavernous fistula: Incidence,clinical presentation, treatment, andoutcome[J]. AJNR, 2006, 27: 185-189.
[3]
Samuels OB, Joseph GJ, Lynn MJ, et al. A standardized method for measuring intracranial arterial stenosis[J]. AJNR Am J Neuroradiol, 2000, 21(4): 643-646.
[4]
Barrow DL, Spector RH, Braun IF, et al. Classification and treatment of spontaneous carotid-cavernous sinus fistulas[J].Neurosurg, 1985, 62: 248-256.
[5]
Yu JS, Lei T, Chen JC, et al. Diagnosis and endovascular treatment of spontaneous direct carotid-cavernons fistula[J]. Chin Med J(Engl), 2008, 121: 1558-1562.
[6]
Preeehawat P, Narmkerd P, Jiarakongmun P, et a1. Dural carotid cavernous sinus fistula: Ocular characteristics,endovascular management and clinical outcome[J]. J Med Assoc Thai, 2008, 91(6): 852-858.
[7]
马廉亭.外伤性颈动脉海绵窦瘘诊治整体策略[J].中国临床神经外科杂志,2006(11): 641-642.
[8]
邱雷,张翔,张全斌,等.Onyx胶栓塞外伤性颈动脉海绵窦瘘的治疗体会[J].中华神经外科杂志,2014, 30(2): 121-124.
[9]
Andrade G, Ponte De Souza ML, Marques R, et a1. Endovascular treatment of traumatic carotid cavernous fistula with balloon-assisted sinus coiling. A technical description and initial restdts[J].Interv Neuroradiol, 2013, 19(4): 445-454.
[10]
Hassan T, Rashad S, Aziz W, et al. Endovascular modalities for the treatment of cavernous sinus arteriovenous fistulas: A single-center experience[J]. J Stroke cerebrovasc Dis, 2015, 24(12): 2824-2838.
[11]
Wang W, Li MH, Li YD, et a1. Reconstruction of the internal carotid artery after treatment of complex traumatic direct carotid-cavernous fistulas With the Willis covered stent: A retrospective study with long-term follow up[J]. Neurosurgery, 2016, 79(6): 794-805.
[12]
Samaniego EA, Martinez-Galdamez M, Abdo G.Treatment of direct carotid-cavernous fistulas with a double lumen balloonl[J]. J Neurointerv Surg, 2016, 8(5): 531-535.
[13]
王武,李明华,顾斌贤.Willis覆膜支架治疗难治性外伤性颈动脉海绵窦瘘[J].介入放射学杂志,2011, 20(3): 177-180.
[1] 陆婷, 范晴敏, 王洁, 万晓静, 许春芳, 董凤林. 超声引导下经皮穿刺置管引流对重症急性胰腺炎的疗效及应用时机的选择[J]. 中华医学超声杂志(电子版), 2024, 21(05): 511-516.
[2] 仲卫冬, 胡根, 邵国益. 腹腔开放合并肠空气瘘的管理[J]. 中华损伤与修复杂志(电子版), 2024, 19(05): 462-462.
[3] 张超, 张珍, 马梁, 穆欢欢, 刘彩玲. 腹腔镜胰十二指肠切除术术后C级胰瘘患者临床特征及影响因素研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(06): 675-678.
[4] 姜宁宁, 蔺艳丽, 陈惠明. 胆总管结石患者腹腔镜胆总管探查术中应用“三针法”缝合方案的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(05): 531-534.
[5] 麦子结, 曾学晴, 张乾升, 刘永达. 输尿管软镜术后严重出血治疗的初步探索[J]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 366-371.
[6] 胡海涛, 邵欣欣, 姜玉娟, 王鹏, 李维坤, 卢一鸣, 田艳涛. 十二指肠残端处理对全腹腔镜胃癌根治术后并发症的影响[J]. 中华腔镜外科杂志(电子版), 2024, 17(04): 205-209.
[7] 陈卫波, 朱玉文, 杨豪, 陆泽坤, 邬迪, 祖广晨, 张悦, 陈学敏. 一种改良胰肠吻合方式安全性及其在腹腔镜和开腹胰十二指肠切除术中应用比较[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 498-503.
[8] 杜成旭, 李冬瑞, 张树彬, 李秋生, 邢中强, 王天阳, 赵伟红, 刘建华. 新胰胃吻合在腹腔镜胰腺中段切除术中的应用价值[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 504-508.
[9] 危用洋, 黄俊甫, 辛万鹏, 易思清, 涂书举, 方康, 李勇, 肖卫东. 三种术式治疗胰腺颈体部良性或低度恶性肿瘤的临床疗效分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 515-519.
[10] 邢颖, 程石. 巨脾外科治疗现状与介入治疗序贯手术策略[J]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 253-258.
[11] 陆雅斐, 皇甫少华, 马传学, 江滨. 间充质干细胞治疗肛瘘手术方式的研究进展[J]. 中华结直肠疾病电子杂志, 2024, 13(03): 242-249.
[12] 杨金朔, 吴桥伟, 王春雷, 史怀璋. 脑血管内支架成形术后再狭窄的研究进展[J]. 中华神经创伤外科电子杂志, 2024, 10(03): 174-179.
[13] 单志强, 吉宏明, 贾贵军. 脊髓硬脊膜动静脉瘘诊疗的研究进展[J]. 中华神经创伤外科电子杂志, 2024, 10(03): 180-185.
[14] 李春光, 杨洋, 李斌, 华荣, 孙益峰, 李志刚. 不同外科修复模式治疗机械通气相关气管食管瘘的短期疗效评价[J]. 中华胸部外科电子杂志, 2024, 11(03): 151-157.
[15] 周洪千, 张煜坤, 顾天舒, 胡苏涛, 姜超, 张雪, 张昊, 陶华岳, 刘行, 刘彤, 陈康寅. 既往出血性脑卒中患者行经皮冠脉介入治疗后不良事件的危险因素分析[J]. 中华脑血管病杂志(电子版), 2024, 18(04): 323-329.
阅读次数
全文


摘要