眼动脉解剖在颈内动脉眼动脉段动脉瘤显微手术治疗中的应用疗效观察
发布时间：2019-02-26 11:47
【摘要】：目的研究眼动脉及其周围组织结构的解剖间隙和解剖关系,探讨其眼动脉解剖应用在颈内动脉眼动脉段动脉瘤的显微手术治疗中的手术技巧、应对策略和疗效观察。方法选择20具成人国人尸头,共40侧,做眼动脉的灌注和解剖,进行观察和测量,研究其眼动脉的周围组织结构及其解剖关系。以单人单中心回顾性研究的方法纳入青大附院神经外科由丰育功教授主刀完成的自1996年10月至2015年12月之间经翼点入路行颅内眼动脉动脉瘤夹闭术的病人共计42例,占所有在此时间内由术者所行颅内动脉瘤夹闭术的患者的2.7%。观察和统计42例颈内动脉眼动脉段动脉瘤患者的基本资料、手术治疗和术后疗效等相关临床资料,对相关显微手术治疗策略进行探讨。结果42例颈内动脉眼动脉段动脉瘤患者中,总计44个颈内动脉眼动脉段动脉瘤,全部经过开颅手术夹闭治疗。术中在分离和暴露动脉瘤过程中未发生破裂的动脉瘤计数41个,占总数的93.2%,发生破裂的动脉瘤计数3个,占总数的6.8%。33例眼动脉段动脉瘤患者术后未出现相应并发症,其中共2例患者因ICA闭塞而发生大面积脑梗死造成死亡,共计6例患者术后视力未改善(包括术前已经存在视力障碍或丧失的患者),有1例患者术后发生硬膜外血肿造成二次手术。根据格拉斯哥预后分级(Glasgow Outcome Scale,GOS)将研究组内42例患者的动脉瘤显微手术治疗预后分为四级:Ⅳ级(治愈,无遗留相关神经功能障碍,完全恢复正常工作和生活),共计39例,占总体的92.8%;Ⅲ级(自理,指有轻微的神经功能障碍,但日常的生活能自理),共计数1例,占总体的2.4%;无Ⅱ级(有重度的神经功能障碍,正常生活不能自理)病人;Ⅰ级(死亡),共计数2例,占颈内动脉眼动脉段动脉瘤患者总体的4.8%。结论颈内动脉眼动脉的发出与眼动脉瘤的解剖位置密切相关,掌握眼动脉及周围解剖是颈内动脉眼动脉段动脉瘤显微手术治疗、获得良好治疗效果的基础,可以有效的减少误损伤和并发症的发生。在处理大动脉瘤和复杂动脉瘤时,根据病人的个体差异,根据需要行颈内动脉的解剖或瘤体临时阻断,在眼动脉瘤的减压、阻断和夹闭中有较好效果。在磨除前床突的过程中,选择规格合适的磨头,减少和消除在磨除视神经管骨质的过程中高速磨钻产生的热量,封堵开放的气房,可以有效降低磨除骨质的过程中高速磨钻产生的热损伤并减少脑脊液漏等并发症的发生。
[Abstract]:Aim to study the anatomic space and anatomic relationship of the ophthalmic artery and its surrounding tissue structure, and to explore the operative techniques, coping strategies and therapeutic effects of the ophthalmic artery anatomy in the microsurgical treatment of the aneurysm of the ophthalmic artery segment of the internal carotid artery. Methods Twenty adult Chinese cadaveric heads (40 sides) were used to observe and measure the perfusion and anatomy of the ophthalmic artery to study the surrounding tissue structure and anatomic relationship of the ophthalmic artery. A single, single-center retrospective study was performed in the neurosurgery department of the affiliated Hospital of Qingda University. From October 1996 to December 2015, a total of 42 patients underwent intracranial ophthalmic aneurysm closure via the pterygoid approach from October 1996 to December 2015, with a total of 42 cases of neurosurgery performed by Professor Fengyukong. It accounted for 2.7% of all patients who underwent intracranial aneurysm clamping at this time. The clinical data of 42 patients with aneurysm of the internal carotid artery segment of the ophthalmic artery were observed and counted, and the related clinical data, such as surgical treatment and postoperative curative effect, were observed and counted, and the strategies of microsurgical treatment were discussed. Results A total of 44 aneurysms of the ophthalmic segment of the internal carotid artery were treated by craniotomy in 42 patients with aneurysms of the segment of the ophthalmic artery of the internal carotid artery. During the operation, 41 aneurysms (93.2%) were not ruptured during the separation and exposure of aneurysms, and the number of ruptured aneurysms was 3. 33 patients with ophthalmic artery aneurysm had no corresponding complications after operation, 2 of them died due to large area cerebral infarction due to ICA occlusion. A total of 6 patients had no improvement in postoperative visual acuity (including those who had visual impairment or loss before operation), and one patient had postoperative epidural hematoma resulting in secondary surgery. According to Glasgow Prognostic grading (Glasgow Outcome Scale,GOS), the microsurgical treatment of aneurysm in 42 patients in the study group was divided into four grades: grade 鈪，
本文编号：2430739
[Abstract]:Aim to study the anatomic space and anatomic relationship of the ophthalmic artery and its surrounding tissue structure, and to explore the operative techniques, coping strategies and therapeutic effects of the ophthalmic artery anatomy in the microsurgical treatment of the aneurysm of the ophthalmic artery segment of the internal carotid artery. Methods Twenty adult Chinese cadaveric heads (40 sides) were used to observe and measure the perfusion and anatomy of the ophthalmic artery to study the surrounding tissue structure and anatomic relationship of the ophthalmic artery. A single, single-center retrospective study was performed in the neurosurgery department of the affiliated Hospital of Qingda University. From October 1996 to December 2015, a total of 42 patients underwent intracranial ophthalmic aneurysm closure via the pterygoid approach from October 1996 to December 2015, with a total of 42 cases of neurosurgery performed by Professor Fengyukong. It accounted for 2.7% of all patients who underwent intracranial aneurysm clamping at this time. The clinical data of 42 patients with aneurysm of the internal carotid artery segment of the ophthalmic artery were observed and counted, and the related clinical data, such as surgical treatment and postoperative curative effect, were observed and counted, and the strategies of microsurgical treatment were discussed. Results A total of 44 aneurysms of the ophthalmic segment of the internal carotid artery were treated by craniotomy in 42 patients with aneurysms of the segment of the ophthalmic artery of the internal carotid artery. During the operation, 41 aneurysms (93.2%) were not ruptured during the separation and exposure of aneurysms, and the number of ruptured aneurysms was 3. 33 patients with ophthalmic artery aneurysm had no corresponding complications after operation, 2 of them died due to large area cerebral infarction due to ICA occlusion. A total of 6 patients had no improvement in postoperative visual acuity (including those who had visual impairment or loss before operation), and one patient had postoperative epidural hematoma resulting in secondary surgery. According to Glasgow Prognostic grading (Glasgow Outcome Scale,GOS), the microsurgical treatment of aneurysm in 42 patients in the study group was divided into four grades: grade 鈪，
本文编号：2430739
本文链接：https://www.wllwen.com/yixuelunwen/waikelunwen/2430739.html
最近更新
教材专著
