摘要
目的探讨早、中期显微手术治疗颅内动脉瘤破裂的方法，讨论术中、术后出现的并发症及治疗方法。方法回顾性分析36例颅内动脉瘤患者临床资料，入院前均经头颅CT检查证实有蛛网膜下腔出血存在，35例患者经全脑血管造影检查证实为颅内动脉瘤，1例经手术探查证实右侧A2段动脉瘤。36例患者均在早、中期进行显微手术治疗，早期蛛网膜下腔出血后3d内手术22例，中期蛛网膜下腔出血后4—10d内手术14例。结果格拉斯哥预后评分Ⅰ级21例，Ⅱ级4例，Ⅲ级4例，Ⅳ级4例。术后均复查头颅CT，无术后颅内血肿，不同部位脑梗死5例。死亡3例，1例为后交通动脉动脉瘤夹闭后发生枕叶梗死，发生脑疝，家属放弃治疗；1例为Hunt—HessⅤ级的前交通动脉瘤患者，术后脑疝症状未解除；1例为前交通动脉瘤栓塞术后2年再发出血，手术夹闭后1周突发枕骨大孔疝。术后26例患者行全脑血管造影复查，1例患者提示前交通动脉瘤完全未被夹闭，1例后交通动脉瘤有残颈，l例后交通动脉瘤患者示后交通动脉未显影。结论早、中期显微手术是治疗颅内动脉瘤的有效方法。术后脑缺血是颅内动脉瘤手术的严重并发症，特别是颈内动脉后交通段动脉瘤，术中对后交通动脉的保护十分重要。对载瘤动脉及动脉瘤体内血栓形成或粥样硬化患者的手术治疗还需进一步研究。
Objective To explore the microsurgical method in treating ruptured aneurysms treatment and evaluating the treatment of the complication during or after the operation. Methods 36 cases of patients with intracranial aneurysm were analyzed retrospectively. All of the patients were subarachnoid hemorrhage （SAH） by CT scan on admission. The intracranial aneurysms were confirmed in 35 cases by DSA examination and A2 aneurysm was confirmed by explorative operation in 1 case. The mierosurgieal treatment was performed in 36 cases at the early or intermediate stage ,22 cases were treated in the early stage ,the other 14 cases were treated in the intermediate stage （early stage means within 3 days post SAH; intermediate stage means from 4 days to I0 days post SAH）. Results After the operation,21 cases were GOS grade I ,4 cases were GOS grade ]/ ,4 cases were GOS grade /~ ,4 cases were GOS grade IV. Of all the patients, CT scan was done after the operation, finding no intracranial hemorrhage, and cerebral infarction was disclosed in 5 cases. 3 cases were dead, one suffered occipital lobe infarct after the PCoA aneurysm clipped,brain hernia occurred at last, one＇s Hunt Hess grade was V, ACoA aneurysm was disclosed by DSA examination, severe brain edema occurred after the operation, the other suffered tonsillar hernia one week after the aneurysm clipping,which ruptured after endovascular treatment of ACoA aneurysm 2 years later. DSA examina- tions were done in 26 cases after operation, declaring 1 ACoA aneurysm was unclipped, 1 PCoA aneurysm was incom- pletely clipped, and 1 PCoA was sacrificed . Conclusions It is a valuable method to clip the ruptured intraeranial aneurysms in early and intermediate stage. The cerebral ischemia is the severe complication after clipping. Especially for the PCoA aneurysms,it is very important to protect the PCoA . Further research should be done for the treatment in the case with mother artery arteriosclerosis and thrombosis within the aneurysms.
出处
《中国综合临床》
2009年第12期1301-1303,共3页
Clinical Medicine of China
关键词
颅内动脉瘤
显微外科手术
颅内出血
Intracranial aneurysms
Microsurgical treatment
Intracranial hemorrhage
