颅内动脉瘤诊疗策略探讨  

Exploration of diagnosis and treatment for intracranial aneurysm

作　　者：陈苏[1] 高进喜[1] 王如密[1] 王守森[1] 刘峥[1] 郑兆聪[1] 张小军[1] 杨朋范[1] 荆俊杰[1] 陈宏颉[1] 

机构地区：[1]南京军区福州总医院神经外科,福州350011

出　　处：《中国综合临床》2008年第10期1007-1009,共3页Clinical Medicine of China

基　　金：福建省青年人才基金项目（2005J073）

摘　　要：目的探讨颅内动脉瘤诊断方法的选择以及开颅直接手术或采取血管内介入手术的取向等问题。方法190例颅内动脉瘤患者中术前均行颅脑CT检查，MRI检查37例、MRA31例，通过重建CT血管成像技术（CTA）及三维CTA（3D—CTA）确诊134例；数字减影血管造影（DSA）／3D—DSA确诊142例；直接手术96例，其中因血管内手术失败而开颅4例；采用血管内介入治疗92例，其中ONYX胶栓塞2例，其余均采用GDC栓塞手术。另6例因再次出血，病情恶化等原因家属放弃治疗。结果死亡9例，死因：2例再出血、3例严重血管痉挛，肺炎等并发症死亡4例；其余均痊愈出院。结论CT为蛛网膜下腔出血的首诊选择，MRA可作为无出血史患者的检查，但不宜以此直接手术；CTA／3D—CTA在相当患者中可以确定动脉瘤的大小、部位、供血动脉及破裂点，并依此直接手术；DSA尤其3D—DSA对复杂性的动脉瘤的血供情况可清晰提示并指导手术。血管内栓塞治疗和直接开颅夹闭手术各有优点，我们主张急性期脑肿胀患者应首先行急诊介入治疗，但血管痉挛明显的患者应果断早期手术，其中多发性动脉瘤的重点是判断责任动脉瘤。Objective To discuss the selection of diagnosis for intracranial aneurysms,and to analyze therapeutic efficacy of microsurgical treatment and endovascular embolization in the treatment of intracranial aneurysms. Methods 190 patients sufferring from intracranial aneurysms experienced brain CT examination. 37 cases detected by MRI,31 cases detected by MRA,134 cases were confirmed by computered tomographic angiography （CTA） or 3D-CTA,and 142 cases were confirmed by digital subtract angiography （DSA）. 96 patients underwent microsurgical treatment ,4 of whom failed in endovascular embolization. 92 cases underwent endovascular therapy ,2 of whom were embolized by ONYX,and the other were embolized by guglielmi detachable coil （ GDC）. Results 9 patients died,2 of whom died of re-hemorrhage,3 died of severe vasospasm,4 died of pneumonia and other complications, and the others were cured. Conclusion CT is the first choice for the subarachniod hemorrhage; MRA could be a choice for the detection of intracranial aneurysm without hemorrhage,but is not suit for the aneurysm clipping. The size,form, relationship with patent arteries, and even the ruptured point of aneurysms can be clearly demonstrated by CTA, and CTA can be used to the operation for intracranial aneurysms directly. DSA,especially 3D-DSA can display the blood supply of the complicated aneurysms clearly,and can guide the treatment for intracranial aneurysms directly. Endovascular therapy and aneurysm clipping seem like complimentary than competitive,patients with acute cerebral edema should try to undergo endovascular therapy,while the patients with severe vasospasm should be treated with microsurgical operation immediately and resolutely. The ruptured aneurysms in multiple intracranial aneurysm should be identified correctly and treated in the early stage.

关 键 词：颅内动脉瘤 动脉瘤夹闭术 血管内介入治疗 

分 类 号：R651.12[医药卫生—外科学]