应用复合手术室治疗颅内动脉瘤的临床分析

发布时间：2018-05-24 04:30

本文选题：颅内动脉瘤 + 术中血管造影　；参考：《中国微侵袭神经外科杂志》2016年11期

【摘要】：目的探索应用复合手术室在颅内动脉瘤的治疗经验。方法回顾性分析应用复合手术室治疗94例(共110个动脉瘤)颅内动脉瘤病例资料,87例行手术夹闭,4例行颞浅动脉-大脑中动脉(STA-MCA)搭桥术加载瘤动脉血管内弹簧圈闭塞术,2例行STA-MCA搭桥术加动脉瘤切除后断端吻合术,1例行动脉瘤孤立术。结果 87例(103个动脉瘤)病人行动脉瘤夹闭术,造影证实完全夹闭动脉瘤,其中术中血管造影显示动脉瘤颈残留6个(5.8%),调整动脉瘤夹后造影显示动脉瘤均完全夹闭。术中造影显示载瘤动脉狭窄7个(6.8%),调整动脉瘤夹后造影显示载瘤动脉狭窄恢复正常6个,因载瘤动脉瘤化及钙化斑块存在未予调整仍存在轻度狭窄1个(0.9%),电生理监测未显示异常。4例(4个)MCA蛇形动脉瘤先行STA-MCA搭桥术再行载瘤动脉弹簧圈闭塞术,2例(2个)M1段蛇形动脉瘤先行STA-MCA搭桥术再行动脉瘤切除及断端吻合术,血管均重建成功,术中造影未发现吻合血管狭窄或闭塞。1例(1个)M2段夹层动脉瘤行孤立术者,电生理监测未显示异常。术后根据改良Rankin量表评分(m RS),随访79例,时间3~12个月,其中恢复良好(m RS 0分)67例,轻度神经功能障碍(m RS 1~2分)9例,重残(m RS 5分)2例,死亡(m RS 6分)1例。失访15例。结论复合手术治疗颅内动脉瘤安全有效,特别对治疗复杂颅内动脉瘤具有较大优势,能明显降低手术并发症发生率,提高疗效,是今后发展方向。
[Abstract]:Objective to explore the experience of compound operating room in the treatment of intracranial aneurysms. Methods the data of 94 cases (110 aneurysms) of intracranial aneurysms treated with compound operating room were retrospectively analyzed. 87 cases of intracranial aneurysms were clipped and 4 cases of superficial temporal artery and middle cerebral artery (STA-MCA) were grafted to load the endovascular coil of aneurysm. Obliteration was performed in 2 patients with STA-MCA bypass grafting and anastomosis after aneurysm resection, and aneurysm isolation was performed in 1 patient. Results 87 patients (103 aneurysms) underwent aneurysm clipping. The aneurysms were completely clipped by angiography. During the operation, 6 aneurysms were found to remain in the neck of the aneurysms, and the aneurysms were completely clipped after adjusting the aneurysm clip. Intraoperative angiography showed 7 aneurysm stenosis and 6. 8% aneurysm stenosis. After adjusting the aneurysm clip, the aneurysm stenosis returned to normal in 6 cases. Due to the unadjusted plaque of aneurysm carrier and calcification, there was a slight stenosis of 0. 9%, and electrophysiological monitoring showed no abnormality in 4 cases (4 cases of serpentine aneurysm were treated by STA-MCA bypass graft and 2 cases underwent coils occlusion of aneurysm carrying artery) (2 cases). The snake-shaped aneurysms of M 1 segment were treated by STA-MCA bypass grafting, and then aneurysm resection and anastomosis were performed. All the vessels were reconstructed successfully. No anastomosis stenosis or occlusion was found in the intraoperative angiography (1 case of M 2 dissecting aneurysm underwent isolated operation, no abnormal electrophysiological monitoring was found. According to the modified Rankin scale, 79 cases were followed up for 3 ~ 12 months. Among them, 67 cases had good recovery, 9 cases had mild neurological dysfunction, 2 cases had severe disability, and 1 case died. There were 15 cases of missing visit. Conclusion compound operation is safe and effective in the treatment of intracranial aneurysms, especially in the treatment of complex intracranial aneurysms. It can significantly reduce the incidence of surgical complications and improve the curative effect. It is the direction of development in the future.
【作者单位】：沈阳军区总医院神经外科;
【基金】：辽宁省科技攻关项目(编号:2011225021,2013225089) 辽宁省自然科学基金(编号:2015020415)
【分类号】：R651.12

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