大脑中动脉动脉瘤的外科治疗及大脑中动脉的显微解剖研究
发布时间：2018-10-12 17:35
【摘要】：目的:为提高大脑中动脉动脉瘤(MCAA)的诊断和治疗水平,总结155例MCAA的临床资料,分析其治疗方法,探讨预后相关因素,并结合尸头标本进行大脑中动脉(MCA)的显微解剖研究,为临床工作提供参考。 方法:一、回顾性分析1996～2005年间收治的MCAA155例,总结临床表现、影像学资料、治疗和术后并发症等情况,并探讨MCAA开颅手术治疗的预后影响因素。 二、应用手术显微镜对尸头标本进行MCA的显微解剖研究,为临床工作提供参考。 结果:本组资料包括单发MCAA133例,其中87例行手术治疗,预后良好54例,预后差33例,包括5例死亡;46例行栓塞治疗,预后良好39例,预后差7例,包括1例死亡。对手术治疗的单发MCAA进行预后相关因素分析,单因素分析显示:Hunt-Hess分级、术前合并颅内血肿、手术时机、年龄和术前出血次数为有统计学意义的预后因素;多因素分析显示术前Hunt-Hess分级和年龄同预后有关,为预后的独立危险因素。存在MCAA的多发动脉瘤(MIA)22例,手术治疗15例,术后预后良好11例,预后不良4例;栓塞治疗7例,预后良好6例,死亡1例。MCA的显微解剖研究显示,Ml起始部动脉外径3.13±0.12mm(2.56～4.22mm);M1段分叉部为单干型5%,双干型85%,三干型10%;分叉前M1段长度为14.38±1.32 mm(10.28～33.58mm);20条MCA共有豆纹动脉151条,平均每条MCA7.55±2.16条。最大的皮质动脉是颞枕动脉。 结论:MCA是颅内动脉瘤的好发部位之一,手术治疗是治疗MCAA的首选方法;对部分MCAA患者,栓塞治疗同样可达到较好疗效,栓塞治疗的难点在
[Abstract]:Objective: to improve the diagnosis and treatment of middle cerebral aneurysm (MCAA), to summarize the clinical data of 155 cases of MCAA, to analyze the treatment methods, to explore the prognostic factors, and to study the microanatomy of (MCA) in middle cerebral artery (MCA) combined with cadaveric specimens. To provide reference for clinical work. Methods: first, we retrospectively analyzed the clinical manifestations, imaging data, treatment and postoperative complications of patients with MCAA155 from 1996 to 2005, and discussed the prognostic factors of MCAA craniotomy. Secondly, the MCA microanatomy of cadaveric head specimens was studied by using surgical microscope to provide reference for clinical work. Results: there were 87 cases of single MCAA133 with good prognosis (54 cases) and poor prognosis (33 cases including 5 deaths) while 46 cases had good prognosis (39 cases) and poor prognosis (7 cases including 1 death). The prognostic factors of single MCAA were analyzed. Univariate analysis showed that Hunt-Hess grade, preoperative complicated intracranial hematoma, operative timing, age and times of preoperative hemorrhage were statistically significant prognostic factors. Multivariate analysis showed that preoperative Hunt-Hess grade and age were independent risk factors for prognosis. In 22 cases of multiple aneurysms with MCAA, 15 cases were treated surgically, 11 cases had good prognosis and 4 cases had poor prognosis, 7 cases were treated with embolization, 6 cases had good prognosis. The microanatomical study of MCA showed that the external diameter of the artery in the initial part of Ml was 3.13 卤0.12mm (2.56~4.22mm), the branching part of M1 segment was 5 in single trunk, 85 in double trunk, 10 in triple trunk, the length of M1 segment before bifurcation was 14.38 卤1.32 mm (10.28~33.58mm), and there were 151 soybean striated arteries in 20 MCA with an average of MCA7.55 卤2.16. The largest cortical artery is the temporal occipital artery. Conclusion: MCA is one of the most common sites of intracranial aneurysms, and surgical treatment is the first choice in the treatment of MCAA.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R651.1;R322
本文编号：2267008
[Abstract]:Objective: to improve the diagnosis and treatment of middle cerebral aneurysm (MCAA), to summarize the clinical data of 155 cases of MCAA, to analyze the treatment methods, to explore the prognostic factors, and to study the microanatomy of (MCA) in middle cerebral artery (MCA) combined with cadaveric specimens. To provide reference for clinical work. Methods: first, we retrospectively analyzed the clinical manifestations, imaging data, treatment and postoperative complications of patients with MCAA155 from 1996 to 2005, and discussed the prognostic factors of MCAA craniotomy. Secondly, the MCA microanatomy of cadaveric head specimens was studied by using surgical microscope to provide reference for clinical work. Results: there were 87 cases of single MCAA133 with good prognosis (54 cases) and poor prognosis (33 cases including 5 deaths) while 46 cases had good prognosis (39 cases) and poor prognosis (7 cases including 1 death). The prognostic factors of single MCAA were analyzed. Univariate analysis showed that Hunt-Hess grade, preoperative complicated intracranial hematoma, operative timing, age and times of preoperative hemorrhage were statistically significant prognostic factors. Multivariate analysis showed that preoperative Hunt-Hess grade and age were independent risk factors for prognosis. In 22 cases of multiple aneurysms with MCAA, 15 cases were treated surgically, 11 cases had good prognosis and 4 cases had poor prognosis, 7 cases were treated with embolization, 6 cases had good prognosis. The microanatomical study of MCA showed that the external diameter of the artery in the initial part of Ml was 3.13 卤0.12mm (2.56~4.22mm), the branching part of M1 segment was 5 in single trunk, 85 in double trunk, 10 in triple trunk, the length of M1 segment before bifurcation was 14.38 卤1.32 mm (10.28~33.58mm), and there were 151 soybean striated arteries in 20 MCA with an average of MCA7.55 卤2.16. The largest cortical artery is the temporal occipital artery. Conclusion: MCA is one of the most common sites of intracranial aneurysms, and surgical treatment is the first choice in the treatment of MCAA.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2006
【分类号】：R651.1;R322
【引证文献】
相关硕士学位论文 前1条
1 赵大巍;影响颅内动脉瘤破裂伴颅内血肿行手术治疗预后因素的分析[D];河北医科大学;2012年
，本文编号：2267008
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