颅内动脉瘤手术技巧与术中破裂的预见及处理  

Operative techniques for intracranial aneurysms, forecast and management of intraoperative aneurysm rupture

作　　者：张志文[1] 李安民[1] 郭晓明[1] 傅相平[1] 闫润民[1] 查炜光[1] 刘爱军[1] 易林华[1] 梁树立[1] 杜程刚[1] 耿峰[1] 姚世斌[1] 薛菁晖[1] 

机构地区：[1]解放军总医院第一附属医院神经外科,北京100037

出　　处：《中华神经外科疾病研究杂志》2006年第6期498-501,共4页Chinese Journal of Neurosurgical Disease Research

摘　　要：目的探讨颅内动脉瘤夹闭术的手术技巧、术中可能发生破裂出血的相关影像学改变、针对可能发生破裂出血的预案制定以及处理方法。方法本组42例颅内动脉瘤,其中男18例,女24例,平均年龄47岁。41例采用翼点入路行前循环动脉瘤显微直视夹闭手术,另1例大脑后动脉P2段巨大动脉瘤采用颞下入路行夹闭切除术。结果术后痊愈39例,偏瘫2例;术中动脉瘤破裂7例(占16.7%),破裂出血动脉瘤成功夹闭后,6例恢复良好,1例因发生全脑多发性梗塞而死亡。结论显微镜下充分显露载瘤动脉后夹闭动脉瘤是预防并成功处理术中动脉瘤破裂出血的关键;对于DSA/3D-DSA呈葫芦状、宽颈及瘤体另有囊泡(子囊)形成的动脉瘤,应警惕术中发生动脉瘤破裂出血的可能。Objective To discuss the techniques of microsurgical treatment for intracranial aneurysms, analyze the characters of intraoperative aneurysm rupture by DSA/3D-DSA imaging and its managements. Methods There were 42 cases of intracranial aneurysms including 18 males and 24 females with an average of 47 years old. A total of 41 cases were performed neck clipping via pterional approach, while 1 case of giant aneurysm located at P2 segment of posterior cerebral artery was resected after proximal parent artery was clipped with subtemporal approach. Results A total of 39 cases showed favorable outcomes, 2 cases presented henfiplegia, and 1 case was dead because of multiple cerebral infarction after operation, lntraoperative aneurysm rupture rate was 16. 7% （7 out of 42 patients）. For the patients of aneurysm rupture, 6 cases obtained favorable outcomes after clipping and 1 case was dead. Conclusion Delicate microsurgical procedure is the key for the management of neck clipping and avoiding intraoperative aneurysm rupture. For the aneurysms with calabash shape, broad neck or other small vesicles （daughter sacs） on DSA/3D-DSA imaging, much attention should be paid to the intraoperative aneurysm rupture.

关 键 词：动脉瘤 手术 术中破裂 

分 类 号：R651.122[医药卫生—外科学]