床突上段血泡样动脉瘤诊断及手术治疗的临床分析（附5病例分析）

发布时间：2018-03-12 11:47

本文选题：颅内动脉瘤　切入点：蛛网膜下腔出血　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:目前对于颈内动脉床突上段血泡样动脉瘤(BBA)的临床研究甚少。本研究总结5例BBA患者的临床资料及治疗经验。探讨血泡样动脉瘤患者的诊断标准,以及可选择的不同术式及预后,为临床提供参考。临床资料和方法:回顾性分析2010年12月至2016年12月期间在吉林大学中日联谊医院神经外科收治的5例BBA患者的一般临床资料、诊治过程及随访结果。其中:男性患者2例,女性患者3例,年龄43~56岁,平均48岁,合并高血压病史4例,糖尿病病史2例,均无明显头颈部外伤病史。首发症状均表现为剧烈头痛,同时伴有意识不清2例,恶心、呕吐3例,言语不清、肢体活动不灵等缺血表现2例。头部CT检查,5例患者均显示蛛网膜下腔出血,Hunt-Hess分级II级2例,III级3例。入院急诊行头部CTA检查明确为颅内动脉瘤患者3例,进一步行头部血管照影(DSA)检查后,明确颅内动脉瘤患者2例,其中1例在行3D-DSA检查后明确诊断。5例患者术前均行头部DSA检查,均发现存在不同程度的动脉粥样硬化。5例颈内动脉床突上段动脉瘤位于颈内动脉前壁3例,前内侧壁2例。开颅手术治疗前,均行CTA和DSA检查,充分评估手术风险,根据术前影像学检查所显示的病变位置、动脉瘤的特点、患者一般状况、手术风险及家属意愿等因素,合理选择手术方案;完善术前准备,早期手术治疗;术后行影像学复查及定期随访。同时,结合相关血泡样动脉瘤诊断治疗的国内外文献进行系统的整理、分析。结果:5例BBA患者中行开颅动脉瘤夹闭术+动脉瘤颈包裹术1例,随访15月,改良Rankin评分1分;单纯动脉瘤包裹术1例,随访12月,改良Rankin评分0分;单纯动脉瘤夹闭术1例,随访43月,改良Rankin评分3分;支架辅助弹簧圈栓塞术1例,随访32月,改良Rankin评分2分;覆膜支架植入术1例,术后患者一般状况差,术后第2日死亡。结论:1.床突上段BBA是一种特殊类型的颅内复杂动脉瘤,应综合考虑患者年龄、Hunt-Hess分级、出血量、动脉瘤指向、家属意愿等因素选择治疗方法。2.开颅手术治疗颅内BBA是可行且有效的手术方法之一。3.在患者经济状况允许的前提下,对于BBA患者,术前同时准备3D-DSA和3D-CTA影像资料,会更有利于BBA的诊断及开颅手术治疗。4.采用特殊的手术技巧,同时娴熟的手术操作,能够减少BBA的手术风险,提高治愈率。5.颈内动脉床突上段血泡样动脉瘤的治疗需要整个神经外科手术团队的合作,更需要介入科医师及麻醉科医师的协调配合。
[Abstract]:Objective: at present, there are few clinical studies on BBA in the upper segment of the internal carotid artery. This study summarized the clinical data and treatment experience of 5 patients with BBA, and discussed the diagnostic criteria of the patients with BBA. The clinical data and methods: from December 2010 to December 2016, the general clinical data of 5 patients with BBA in neurosurgery department of Sino-Japanese Friendship Hospital of Jilin University were analyzed retrospectively. The course of diagnosis and treatment and the results of follow-up were: male 2 cases, female 3 cases, age 4356 years (mean 48 years), history of hypertension 4 cases, diabetes 2 cases. There was no obvious history of head and neck trauma. The initial symptoms were severe headache, accompanied by 2 cases of unclear consciousness, 3 cases of nausea and vomiting, and 3 cases of unclear speech. There were 2 cases of iso-ischemic manifestations of limb inactivity, 5 cases of head CT examination showed subarachnoid hemorrhage, 2 cases of Hunt-Hess grade II and 3 cases of grade III. 3 cases of head CTA were confirmed as intracranial aneurysms. 2 cases of intracranial aneurysm were confirmed after further examination of DSA, and 1 case was diagnosed by 3D-DSA. All the 5 cases were examined with DSA before operation. In all cases, 5 cases of atherosclerosis were found to be located in the anterior wall of the internal carotid artery in 3 cases and 2 cases in the anterior wall of the internal carotid artery. Before craniotomy, CTA and DSA were performed to evaluate the risk of the operation. According to the location of lesion, the characteristic of aneurysm, the general condition of the patients, the risk of operation and the will of the family, the operative plan should be selected reasonably, the preoperative preparation should be improved, and the early operative treatment should be improved. Imaging reexamination and regular follow-up were performed after operation. At the same time, combined with the domestic and international literature on the diagnosis and treatment of the relevant blood blister-like aneurysms, the results were analyzed. Results among the 5 patients with BBA, 1 case underwent closed aneurysm closure with craniotomy and 1 case underwent closed aneurysm neck encapsulation. After 15 months of follow-up, the modified Rankin score was 1; the simple aneurysm encapsulation was performed in 1 case, the modified Rankin score was 0 on December; the simple aneurysm clipping was followed up for 43 months and the modified Rankin score was 3; the stent assisted coils embolization was performed in 1 case. After 32 months follow-up, the modified Rankin score was 2 points, one case was treated with plastic stent implantation, the general condition of the patients was poor and died on 2nd after operation. Conclusion 1. BBA in the upper segment of the clinoid process is a special type of complex intracranial aneurysms. Hunt-Hess grade, bleeding volume, aneurysm direction, family willingness and other factors should be taken into account. 2. Craniotomy is one of the feasible and effective surgical methods for the treatment of intracranial BBA. For BBA patients, the preparation of 3D-DSA and 3D-CTA imaging data before operation will be more beneficial to the diagnosis and craniotomy of BBA .4.Using special surgical techniques and skillful operation can reduce the risk of BBA surgery. To improve the cure rate, the treatment of the superior segment of the internal carotid artery's clinoid process requires the cooperation of the whole neurosurgical team and the coordination of interventional and anesthesiologist.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

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