用国产胶体栓塞剂经血管内治疗脑动静脉畸形

报告了经血管内采用微导管超选择导入技术，并应用国产氰基丙烯酸异丁酯（Ｉｓｏｂｕｔｙ１２－ｃｙａｎｏａｃｒｙｌａｔｅ，ＩＢＣＡ）和α－氰基丙烯酸正丁酯（Ｎ－ｂｕｔｙｌｃｙａｎｏａｃｒｙｌａｔｅ，ＮＢＣＡ）栓塞治疗４４例脑动静脉畸形，获较满意效果。文中就栓塞材料的选择、ＩＢＣＡ和ＮＢＣＡ之间的特点比较及应用方法，栓塞术中并发症的预防与处理等进行了讨论。本组资料表明，国产ＩＢＣＡ和ＮＢＣＡ具有与国外产品性能相似的弥散好、易控制、聚合速度快等优点。     

Study of the mechanisms of formation of nanoparticles and nanocapsules of polyisobutyl-2-cyanoacrylate

Biodegradable colloids suitable for use as drug delivery systems can be formed by in situ polymerization of isobutylcyanoacrylate monomers. In this work we have studied the mechanisms of formation of colloidal systems of PIBCA obtained in the presence of oil and ethanol. For this different analytical techniques have been used (TEM, PCS, GPC). The results have shown that the diffusing ethanol was the most important factor which leads to the structure and colloidal characteristics of the particles by convective effects, the oil playing the role of a monomer support. The existence of an ideal oil/ethanol ratio (2:100) seems to result from the combination of both mechanisms. In the absence of oil and ethanol, IBCA polymerization occurs within micelles appearing in the aqueous phase. However, in the case of nanocapsule formation, owing to the solubility of the monomer in the organic phase and the diffusibility of ethanol, polymerization can develop at the interface. In this latter case, the formation of a double population of nanocapsules and nanoparticles probably arises from the breakdown of the same interfacial polymer.     

混合性脑膜－脑动静脉畸形的血管内栓塞治疗

报告１８例大、中型混合性脑膜－脑动静脉畸形的诊断和血管内治疗。本组均经股动脉或同侧颈动脉置入微导管，采用微钨螺旋圈和氰基丙烯酸酯胶（ＮＢＣＡ，ＩＢＣＡ）或聚乙烯醇颗粒等材料栓塞脑内和脑膜的畸形血管。其中７例经两次栓塞后，畸形血管团消除８０％～９５％；随访３个月至３年，临床头痛及癫痫均得到缓解，未再发生蛛网膜下腔出血。本组资料表明，头痛是脑膜－脑动静脉畸形的重要症状之一；微钨螺旋圈与ＮＢＣＡ或１ＢＣＡ混合栓塞脑内畸形血管团有助于提高栓塞效果；分期栓塞和控制术中与术后的体循环血压可预防或减少栓塞并发症。     

Embolization of glomus tumors of the carotid: Temporary or definitive?

The authors describe the use of preoperative embolization of glomus tumors in 7 patients. In two cases a nonresorbable substance (IBCA) was used for the embolization, and no subsequent operation was needed. They therefore suggest that embolization could be a definitive treatment and an alternative to surgery.     

栓塞与手术切除联合治疗巨大脑动静脉畸形

目的：为防止正常灌注压突破综合症，解决巨大脑动静脉畸形（直径＞６．０ｃｍ）手术切除的困难，降低手术死亡率。方法：术中首先分次结扎供应动脉近端，注入ＩＢＣＡ１．０ｍｌ＋５％葡萄糖１ｍｌ。分离畸形血管团，最后将其全切。术后常规复查脑血管造影。结果：２６例巨大ＡＶＭ′ｓ栓塞后手术全切，无手术死亡。术后短期神经功能缺损加重７例，随访６～３６月（平均１９．５月），２４例恢复正常工作和学习。结论：栓塞与手术切除联合治疗巨大动静脉畸形是治疗巨大动静脉畸形的有效手段。