DSA应用于颅内复杂动脉瘤介入杂交手术中的临床价值

发布时间：2018-09-12 10:47

【摘要】：目的探讨介入杂交手术平台治疗颅内复杂动脉瘤的效果,并观察数字减影血管造影技术(DSA)在手术治疗前后的评估价值。方法采用Solitaire AB支架辅助弹簧圈栓塞治疗颅内动脉瘤17例(共23个动脉瘤),同时比较2D数字减影血管造影技术(2D-DSA)、3D数字减影血管造影技术(3D-DSA)在颅内动脉瘤检出率方面的差异。结果 17例病理证实为颅内动脉瘤患者中2D-DSA共检出16例,1例微小血泡样宽颈动脉瘤因病灶太小漏诊,准确率为94.12%,3D-DSA全部检出,准确率达100.0%,但两种检测方式比较差异无统计学意义(t=1.030,P=0.310)。15例宽颈动脉瘤术中达到致密栓塞;2例未破裂颈内动脉巨大宽颈动脉瘤予以较疏松填塞。1例双侧大脑中动脉宽颈动脉瘤患者因术前出血量大,栓塞治疗后行开颅清除血肿、去骨瓣减压术。全组无死亡病例。术后随访3-30个月,16例恢复工作,1例呈迁延性昏迷状态(治疗3个月)。复查DSA16例动脉瘤消失,1例疏松填塞的巨大颈内动脉宽颈动脉瘤患者,瘤腔仍有血流灌注,但动脉瘤未增大。结论支架辅助弹簧圈栓塞技术能够有效提氋颅内复杂宽颈动脉瘤栓塞治疗的成功率,同时可有效防止再出血,提氋复杂动脉瘤的治愈率,期间应用DSA技术可确保治疗安全性,并对预后做出可靠判断。
[Abstract]:Objective to evaluate the efficacy of interventional hybrid surgery platform in the treatment of complex intracranial aneurysms and to evaluate the value of digital subtraction angiography (DSA) before and after operation. Methods 17 cases (23 aneurysms) of intracranial aneurysms were treated with Solitaire AB stent-assisted coil embolization. The difference of 2D digital subtraction angiography (2D-DSA) and 3D digital subtraction angiography (3D-DSA) in the detection rate of intracranial aneurysms was compared. Results among the 17 patients with intracranial aneurysm confirmed by pathology, 16 cases were detected by 2D-DSA, and 1 case of small bulloid wide carotid aneurysm was misdiagnosed because the lesion was too small, and the accuracy was 94.12% 3D-DSA. The accuracy rate was 100. 0%, but there was no significant difference between the two methods (t1.030% P0. 310). 15 cases of wide carotid aneurysms reached dense embolization during operation. 2 cases of large wide carotid aneurysms without ruptured internal carotid artery were tampered with 1 cases of bilateral middle cerebral artery width. Because of the large amount of bleeding in patients with carotid aneurysms, After embolization, craniotomy was performed to remove hematoma and decompression of bone flap. There were no death cases in the whole group. 16 cases were followed up for 3 to 30 months. 1 case was in a prolonged coma state (3 months). The blood perfusion was found in the aneurysm of the large internal carotid artery, but the aneurysm was not enlarged. Conclusion Stent-assisted coils embolization can effectively improve the success rate of embolization of intracranial complex wide-necked aneurysms, prevent rebleeding, and improve the cure rate of complex aneurysms. During the treatment, the DSA technique can ensure the safety of the treatment. The prognosis was judged reliably.
【作者单位】：湖北省咸宁市中心医院(同济咸宁医院/湖北科技学院第一临床学院)放射科;
【基金】：咸宁市科学技术研究与开发项目,项目编号:咸科技字(2015)-4
【分类号】：R743;R816.1

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