老年单侧烟雾病合并动脉瘤患者外科夹闭治疗后并发症

发布时间：2018-04-19 13:48

本文选题：单侧烟雾病 + 动脉瘤　；参考：《中国老年学杂志》2017年17期

【摘要】：目的探讨老年单侧烟雾病(MMD)合并动脉瘤患者外科夹闭治疗后出现并发症的状况。方法 MMD合并动脉瘤外科夹闭患者13例,男10例,女3例,年龄60~69岁。以蛛网膜下腔出血(SAH)起病者12例,以脑内血肿合并SAH起病者1例。发病后行CT血管成像(CTA)或数字减影血管造影(DSA)检查诊断为单侧MMD合并动脉瘤,13例有动脉瘤14个,动脉瘤位于前交通动脉8个,位于大脑中动脉者3个,其他部位3个。诊断明确后进行外科夹闭治疗,13例中出现缺血并发症6例,出血性并发症2例,术前出血1例,感染并发症3例,癫痫发作1例。治疗后格拉斯哥预后评估量表(GOS)评分5分7例、4分4例、1分2例。结果有的缺血性并发症是血流动力学性,积极治疗后可以取得满意结果;而有的缺血并发症为失平衡性质,发生后预后极差。单侧MMD也可发生出血并发症,而且理论上这些并发症可能会很严重,应该重视。结论由于MMD侧的血管脆弱,代偿能力差,加之脑组织顺应性差,容易出现症状性血管痉挛,术区也容易出血。
[Abstract]:Objective to investigate the complications of surgical clipping in elderly patients with unilateral moyamoya disease (MMD) complicated with aneurysms.Methods Thirteen patients (10 males and 3 females) with MMD complicated with aneurysm were aged 60 to 69 years old.There were 12 cases with subarachnoid hemorrhage and 1 case with intracerebral hematoma with SAH.Ct angiography (MMD) or digital subtraction angiography (DSA) were performed in 13 patients with unilateral MMD accompanied with aneurysm. The aneurysms were located in anterior communicating artery (8 cases), middle cerebral artery (3 cases) and other sites (3 cases).Among the 13 cases of surgical clipping treatment, 6 cases had ischemic complications, 2 cases had hemorrhagic complications, 1 case had bleeding before operation, 3 cases had infection complications, and 1 case had seizures.After treatment, Glasgow prognosis Assessment scale (GOS) score was 5 in 7 cases, 4 in 4 cases and 1 in 2 cases.Results some ischemic complications were hemodynamic, and satisfactory results could be obtained after active treatment, while some ischemic complications were unbalanced and the prognosis was very poor.Bleeding complications can also occur in unilateral MMD, and in theory these complications can be severe and should be taken seriously.Conclusion because of the fragility of the vessels in the MMD side, the poor compensatory ability, and the poor compliance of the brain tissue, symptomatic vasospasm is easy to occur and the area of operation is easy to bleed.
【作者单位】：吉林大学第一医院神经血管病外科;
【分类号】：R651.12

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