摘要
目的探讨后交通动脉动脉瘤的瘤颈位置和分型，以指导手术中动脉瘤夹的选择。方法回顾2007年1月至2012年6月北京大学第一医院单一术者开颅手术夹闭的后交通动脉动脉瘤患者的临床资料，搜集其瘤颈位置、宽窄、术中动脉瘤夹类型和型号等。瘤颈位置按时钟模式的12个钟点方向分类，根据动脉瘤颈与载瘤动脉的关系对动脉瘤进行分型。术后对患者以门诊、电话、脑血管造影进行随访。结果55例后交通动脉动脉瘤开颅夹闭病例纳入研究。瘤颈位置和宽窄按时钟模式的12个钟点方向记录：位于1个钟点的3例，跨两个钟点的42例，跨三个钟点的10例。根据动脉瘤颈与载瘤动脉的关系分为颈内动脉、后交通动脉、分又三种类型。其中分叉型30例、颈内动脉型20例、后交通型5例。84％（46／55，30例分叉型、13例颈内动脉型、3例后交通动脉型）动脉瘤选用弯型动脉瘤夹，11％（6／55）直型，4％（2／55）成角度跨血管型，2％（1／55）枪型。术后随访1个月-5年，所有患者均无动脉瘤复发及破裂的临床表现，21例行DSA检查随访患者动脉瘤颈均夹闭完全，未见动脉瘤残留。结论后交通动脉动脉瘤瘤颈位置和宽窄对动脉瘤夹的选择至关重要，弯型动脉瘤夹在本组后交通各型动脉瘤中使用最多，建议首选。
Objective Studied on aneurismal neck localization and classification in order to facilitate selection of clips during operations for aneurysms of posterior communicating artery （ PcoA ）. Methods Accumulating and analyzinganeurismal neck location, broadness, type of clips of all the PCoA anenrysms operated by single operator between January 2007 and June 2012 based on operative records, retrospectively. Location and broadness of the aneurismal neck was recorded in clock manner. Aneurysm classification was done base on the relation between the aneurismal neck and parent artery. All cases were followed up by means of consulting, telephone, and DSA. Results 55 cases of PCoA aneurysms were enrolled into this study. There were 3 cases, the aneurismal neck located in only one clock region, while 42 cases the neck stepped over two clock region, and 10 cases occupied three clock region. Three types were classified as junctional, internal carotid artery（ ICA）, and true posterior communicating artery, and cases of these types were 30, 20, 5, respectively. Among the clips used during operations, there were 84% （46/55） bent type, 11% （ 6/55 ） straight, 4% （2/55） angled fenestrated, and 2% （1/55） bayonet - shaped. Postoperative follow - up show that all patients recovered well without recurrence and rerupture. Merely twentyone cases went for DSA examination, however, eompleteneck occlusion without residue were demonstrated in all cases. Conclusion The location and broadness of the aneurismal neck of the posterior communicating artery aneurysm was extensively important for clip selecting. According to our experience, bent clip may be the first choice for obliterating PCoA aneurysms.
出处
《中华神经外科杂志》
CSCD
北大核心
2012年第11期1120-1123,共4页
Chinese Journal of Neurosurgery
关键词
后交通动脉动脉瘤
瘤颈位置
分型
瘤夹选择
Posterior communicating artery aneurysm
Location of aneurismal neck
Classification
Choice of clip
