摘要
目的探讨合并有急性硬膜下血肿(SDH)的颅内动脉瘤患者的诊断及外科治疗方法。方法回顾性分析了武汉同济医院2009年4月至2012年5月共9例经影像学及术中证实的合并有急性SDH的颅内动脉瘤患者的影像及临床资料。术前Hunt-Hess分级:Ⅲ级2例;Ⅳ级5例;Ⅴ级2例。术前CT显示伴有SDH 8例,术中探查证实SDH 1例。采用一期手术清除血肿加夹闭动脉瘤者7例,单纯清除血肿而未处理动脉瘤者1例,未手术者1例。结果7例行一期手术患者术后CT血管造影(CTA)复查证实动脉瘤夹闭完全,血肿完全清除。出院时仍遗留肢体偏瘫者5例,2例患者因脑积水需行脑室腹腔分流术。术后GOS评分:恢复良好者2例,轻度残疾2例,重度残疾者3例,死亡2例。结论动脉瘤破裂所致急性硬膜下血肿临床上少见,发病急,病情重,术前如能迅速做出正确诊断,及时地一期手术夹闭动脉瘤并清除血肿,可极大地改善患者的预后。
Objective To explore the diagnosis and surgical treatment of ruptured intraeranial aneurysm with acute subdural hematoma(SDH).Methods The clinical data of 9 patients who were admitted to Tongji Hospital between April 2009 and May 2012 and diagnosed as having intracranial aneurysm complicated with SDH by CT scanning,DSA or CTA and surgery were retrospectively analyzed.There were 2 patients in grade 11,5 in grade IV and 2 in grade V according to the preoperative Hunt-Hess grading.Preoperative CT scanning showed SDH in 8 patients,and 1 patient was confirmed to have SDH by surgical exploration.Seven patients underwent hematoma evacuation and clipping of the aneurysm at one stage operation.One patient was subjected to hematoma evacuation alone,and another one was treated conservatively for the patient refused surgical treatment.Results CTA showed that the subdural hematoma was completely removed and aneurysm clipped in 7 patients who underwent one-stage operation during the hospital stay.Five patients had the body hemiplegia at discharge and 2 patients needed ventriculo-peritoneal shunt due to hydrocephalus.According to the GOS scoring,2 pateints obtained good recovery,2 mild disa-bility,3 severe disability,and there were 2 deaths.Conclusion Acute subdural hematoma caused by ruptured intracranial aneu-rysm is very rare.It undergoes,in general,acute onset and rapid progression and patients often present with poor neurological condition on admission.Accurate diagnosis and emergency one-stage operation can greatly improve the prognosis of patients.
出处
《华中科技大学学报(医学版)》
CAS
CSCD
北大核心
2013年第1期106-110,共5页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
基金
2011年国家临床重点专科项目
关键词
硬膜下血肿
颅内动脉瘤
诊断
治疗
subdural hematoma
intracranial aneurysm
diagnosis
treatment
