摘要
目的 探讨电解可脱弹簧圈 (GDC)治疗颅内动脉瘤的手术指征、术前评估方法、技术操作要点、并发症防治、疗效、存在问题及临床应用前景。方法 1998年 7月至 2 0 0 0年 2月对 93例 118个颅内动脉瘤患者施行了电解可脱卸弹簧圈栓塞术 ,其中 84例为破裂动脉瘤 ,按Hunt Hess分级 :Ⅰ级 18例 ,Ⅱ级 2 9例 ,Ⅲ级 2 5例 ,Ⅳ级 10例 ,Ⅴ级 2例。 72例行急诊栓塞 ,手术在DSA动态监视下完成 ,术后腰椎蛛网膜下腔持续引流 ,并予以 3H(高血容量、高血压、血液稀释 )治疗。结果 动脉瘤完全闭塞 10 4个 (88 14% ) ,栓塞程度达 90 %以上 11个 (9 32 % ) ,栓塞程度在 90 %以下 3个 (2 5 4% )。全组死亡 3例 (3 2 3% )。 1例术后 1 5个月复发出血经手术夹闭痊愈 ,2例术后复查发现瘤颈扩大 ,经再次填塞后痊愈。术后随访 2～ 2 2个月 ,1例 (1 0 7% )重残 ,7例 (7 5 3% )有轻度神经功能缺失症状 ,其余恢复良好。结论 短期随访结果表明 ,GDC栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。致密填塞动脉瘤疗效可靠 ,部分填塞可能导致动脉瘤继续扩大、破裂出血。破裂动脉瘤应急诊栓塞治疗 ,术后腰椎蛛网膜下腔持续引流 ,可明显提高疗效。
Objective To investigate the indication, preoperative evaluation, technical tip, prevention and treatment of complications, effect, and clinical use of the embolization of intracranial aneurysms by using GDCs. Methods From July 1998 to February 2000,93 patients with 118 intracranial aneurysms were embolized using GDCs, including 84 ruptured aneurysms (Hunt-Hess grade, Ⅰ 18 cases, Ⅱ 29 cases, Ⅲ 25 cases, Ⅳ 10 cases, Ⅴ 2 cases). 72 patients were treated at emergency, and 48 patients had CTA examination preoperatively. The operations were completed under the DSA monitoring. Continuous lumbar subarachnoid drainage was instituted and standard 3H treatment was given postoperatively. Results Total occlusion was achieved in 104 aneurysms(88 14%), over 90% in 11aneurysms(9.32%), less than 90% in 3 aneurysms(2 54%), with 3 patients (3/93, 3 23%) died in the cohort. One case rebleeded after 1.5 months and was cured by surgical clipping, 2 patients experienced enlargement of the aneurysmal neck and were reembolized. Following-up was performed from 2 to 22 months, 1 had severe disability, 7 had mild neurological deficit symptoms. Conclusion The results of short-term follow-up suggested that embolization of intracranial aneurysms with GDCs be microtraumatic, safe, effective, and reliable. Partial packing may result in continuous enlargement, rupture, and bleeding, while tight coil packing in aneurysms was reliable. The ruptured aneurysms need emergency embolization, and postoperative continuous lumbar subarachnoid drainage can enhance curative effect significantly.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2001年第6期457-459,共3页
Chinese Journal of Radiology
