血管内栓塞结合显微手术治疗颅内动脉瘤临床研究  

A clinical study that microsurgical clipping combined endovascular embolization therapy of intracranial aneurysm

作　　者：苏平[1] 高鸿[1] 谷震[2] 马钢[3] 刘俊[3] 常谦[3] 孙敏[3] 刘杰[3] 李俊彦[3] 彭远[3] 岑键昌[3] 

机构地区：[1]云南否昆明市第一人民医院神经外科,650011 [2]云南省第二人民医院神经外科 [3]云南省昆明市第一人民医院神经外科,650011

出　　处：《中华显微外科杂志》2007年第3期161-164,共4页Chinese Journal of Microsurgery

基　　金：昆明市科技局重点科技项目(2002-01-20)

摘　　要：目的应用显微手术夹闭、血管内栓塞和栓塞后手术夹闭3种治疗方法,探讨治疗颅内破裂动脉瘤的安全有效方案。方法显微手术瘤颈夹闭30个动脉瘤,栓塞34个动脉瘤。栓塞后夹闭15个动脉瘤。结果夹闭组30个完全夹闭,无复发,死亡率6%(2/30)。栓塞组完全闭塞率70.6%(24/34),复发率17.6%(6/34),死亡率11.8%(4/34)。栓塞后手术组15个完全夹闭,尤复发,死亡率6.7%(1/15)。治疗结束用GOS评价,1个月后3组良好率分别为80.0%、79.4%和80.0%;半年后良好率分别为90.0%、88.2%和86.7%。结论显微手术瘤颈夹闭术仍然是治疗破裂动脉瘤的有效方法,具有1次治疗彻底和复发率低的优势,并可作为栓塞失败的补救手段。Objective To analyzed the treatment of intracranial aneurysms by microsurgical clipping, endovascular embolization and embolization combined clipping therapy. In order to explore the ideal and effective treatment plan of intracranial ruptured aneurysm. Methods The clipped group of 30 aneurysms. The embolized group of 54 aneurysms. The combined group of 15 aneurysms. Results Clipped group： All of aneurysms was clipped well, no recurrence, mortality 6% （2/30）. Embolized Group： complete embolization rate 70. 6% （24/34）, recurrence rate 17.6% （6/34）, mortality 11.8% （4/34）. Combined group： no recurrence, mortality 6.7% （1/15）. All patients of three groups were evaluated by Glasgow Outcome Scale one month later and the rate of recovery well was 80. 0%, 79. 4% and 80. 0%. Following up for six months the data were 90. 0%, 88. 2% and 86.7%. Conclusion Microsurgical clipping aneurysm＇s neck is still an effective therapy. Meanwhile it has an absolute advantage of high completely cure rate and low recurrence rate, furthermore it is an available remediation method for those cases that failure of embolization, and for those recurrence aneurysms that have been embolized, microsurgical clipping should be taken as soon as possible in case of aneurysms re-ruptured. For the patients the aneurysms are narrow shape, irregular shape, small （ ≤ 3 mm） or with cerebral hematomas microsurgical clipping is a fitting choice.

关 键 词：动脉瘤 显微手术 血管栓塞 

分 类 号：R651.12[医药卫生—外科学]