摘要
目的 总结血管内治疗颅内动脉瘤术中常见并发症及其防治经验.方法 回顾性分析福建医科大学省立临床学院近3年来采用血管内治疗的60例颅内动脉瘤患者的临床和随访资料并参考有关文献,探讨减少和处理术中并发症的操作技巧和经验.结果 60例患者血管造影共检出69个囊形动脉瘤和1个椎动脉夹层动脉瘤.65个囊形动脉瘤行血管内弹簧圈栓塞,其中支架辅助栓塞5例,球囊辅助栓塞3例.有50例患者的53个（81.5%）动脉瘤被完全栓塞,5例的8个动脉瘤被次全栓塞（12.3%）,3例的4个（6.2%）被部分栓塞;治疗失败1例.1例椎动脉夹层动脉瘤行载瘤动脉闭塞.发生术中动脉瘤破裂4例;症状性血管闭塞2例;支架移位、弹簧圈脱出1例;术中血管痉挛15例.出院时恢复良好率达93.3%（mRS≤2分）.随访55例（91.6%）,时间1～24个月,恢复良好（mRS≤2分）51例（92.7%）,死亡3例;随访期间无再出血和动脉瘤复发.结论 血管内治疗颅内动脉瘤疗效确切;提高于术操作技巧,减少和正确处理术中并发症有助于改善预后.
Objective To summarize the clinical experience of endovascular intervention for intra-cranial aneurysms, especially in the respect of the technique and management of intra-operative complications. Method The clinical data of 60 patients with intra-cranial aneurysms treated with endovascular intervention in the past 3 years were analyzed. The relevant literature especially with regard to the practical technique described was reviewed so as to potentiall minimize and properly manage the intra-operative complications. Results A total of 69 sacciform aneurysms and one dissecting aneurysm located at left vertebral artery （VA） were detected by using digital subtraction angiography （DSA） in 60 patients. There were 65 saccular aneurysms obliterated with constructive approach, and five of them treated with stent-assisted technique and four of them treated with ballon-assisted technique. The VA dissecting aneurysm was obliterated with coils by deconstructive approach with complete occlusion of its parent vessel. There were a total of 53 complete occlusions of aneurysms accounted for 76.81% of 69 sacciform aneurysms in 51 patients （ 85 % ） and eight subtotal occlusion of aneurysms （95 % ～ 99 % occlusion） accounted for 13.56% of total sacciform aneurysms in five patients （8.47%） and four incomplete occlusion of aneurysms （ 〈 95% occlusion） accounted for 6.78% of total sacciform aneurysms in three patients （5.08%）, and one was failure in operation. The rupture of aneurysms occurred during operation in4 patients （6.78%）. Two senile patients suffered from intra-opeartive symptomatic thromboembolisn. One patient had stent shifting and spring coil dislocated and moved into the M3 segment of the ipsilateral MCA. Vasospasm occurred in 15 patients during operation, and most of them received endovascular intervention 3 days after the initial ictus. The rate of good recovery was 93.3% at discharge from hospital （the modified Rankin Scales, mRS〈 2）. There were 55 patients followed up for up 24 months after discharge, and excellent recovery rate was found in 51 patients （ mRS 〈 2）, and 3 died.During the follow-up period, no aneurismal recanalization or rupture was noticed in all patients. Conclusions The endovascular intervention is a safe and effective approach to the intra = cranial aneurysms. Advances in the skill of technique and proper management will decrease the complications during operation and improve the prognosis of patients.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2010年第12期1258-1261,共4页
Chinese Journal of Emergency Medicine
