破裂脑动脉瘤的早期治疗——血管内介入与内窥镜辅助下瘤颈夹闭  

Early treatment of ruptured intracranial aneurysms:embolization or clipping assisted with endoscope

作　　者：马骏[1] 刘宏毅[1] 常义[1] 韩德清 胡波[1] 杨纶先[1] 黄庆玖[1] 陈永严[1] 赵鹏来[1] 何升学[1] 

机构地区：[1]南京医科大学附属脑科医院神经外科,210029 [2]株洲市第一医院神经外科

出　　处：《临床神经外科杂志》2007年第3期105-107,共3页Journal of Clinical Neurosurgery

基　　金：南京市医学重点科技发展项目(ZKX0305)

摘　　要：目的研究血管内介入与内窥镜辅助下瘤颈夹闭在破裂脑动脉瘤早期治疗中的临床应用。方法对68例破裂的脑动脉瘤进行早期治疗。介入组36例,选用Tracker、Excel、Prowler、Rebar或Echelon系列微导管,以GDC、EDC、Orbit或Microplex微弹簧圈填塞动脉瘤。瘤颈夹闭组32例,术中应用蛇牌内窥镜辅助夹闭瘤颈。结果术后二组病人Hunt-Hess分级、不同部位脑梗死的发生以及临床随访无显著差异。结论二种方法总的临床疗效无明显差异。颅内多发动脉瘤,后循环及海绵窦区动脉瘤患者,栓塞治疗较优于瘤颈夹闭。占位效应明显、合并脑内血肿、出血破入脑室者,瘤颈夹闭较优于栓塞。术前Hunt-Hess分级Ⅳ或Ⅴ级者,二种术式预后均较差。Objective To explore the early treatment of ruptured intracranial aneurysms by embolization or clipping assisted with endoscope. Methods 68 patients with intracranial aneurysms were treated within 3 days after the aneurysms ruptured. 36 cases were embolized. The microcatheter is Tracker, Excel, Prowler, Rebar or Echelon and the coil is GDC, EDC, Orbit or Microplex. 32 cases were clipped assisted with endoscope. Results After treatment, there are nonsignificant differentce in embolizing or clipping group ＇including Hunt-Hess grades, cerebral ischemic infraction and clinical follow visiting. Conclusions The clinical curative effect of the 2 treatment methods do not have obvious discrepancy. But the embolization is better than the clipping in the treatment of multiple aneurysms, aneurysms of vertebral arteryg system, aneurysms in or close by cavernous sinus. And the clipping is better than embolization in the patients with severe intracranial occupying effect, intracranial hematoma and ventricle hemorrhage. The prognosis is poor in patients with Hunt-Hess grades IV or V treated by embolization or clipping.

关 键 词：脑动脉瘤破裂 早期 血管内介入 内窥镜辅助下瘤颈夹闭 

分 类 号：R739.41[医药卫生—肿瘤]