颅内-外动脉吻合术治疗复杂颈内动脉瘤的疗效分析  

Extracranial-intracranial arterial bypass surgery for complex internal carotid arterial aneurysms:an efficacy analysis

作　　者：胡德献[1] 李萌[1] 何川[1] 

机构地区：[1]首都医科大学宣武医院神经外科

出　　处：《中国脑血管病杂志》2008年第10期442-445,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的探讨颅内-外动脉吻合术在治疗复杂颈内动脉瘤中手术方式的选择及其疗效。方法回顾性分析2003年—2008年首都医科大学宣武医院颅内-外吻合术16例患者的临床资料,分别采用高流量吻合术3例,中流量吻合术6例,低流量吻合术7例。观察术后并发症及以DSA随访患者的情况;分析手术方式的选择及手术效果的情况。结果16例患者中,施行高流量吻合术3例,1例术后出现偏瘫和大隐静脉内血栓形成,立即行取栓术,1个月后偏瘫完全恢复;1例术后过度灌注,去骨瓣减压后症状缓解。中流量吻合术6例,2例术后出现不同程度的脑梗死、失语、偏瘫,经扩容及康复理疗后好转。低流量吻合术7例,4例术后出现不同程度的偏瘫,也经扩容及康复理疗后好转。所有患者术后1~2周复查DSA,均显示载瘤动脉闭塞完全。所吻合的血管除一例单支闭塞外,其余血流均畅通,吻合口远端血管充盈良好,动脉瘤不再充盈显影。16例患者术后平均随访3.5年,随访期间均未见动脉瘤复发和破裂出血。结论颅内-外动脉吻合术是治疗复杂颈内外动脉瘤的一种有效手段。选择适合的手术术式是手术成功的关键;及时对术后并发症进行处理,就可以避免出现新发生的神经系统损伤症状。Objective To investigate the efficacy of extracranial-intracranial （EC-IC） arterial bypass surgery and the selection of operative styles for the treatment of complex internal carotid aneurysms.Methods The clinical data of 16 patients who accepted EC-IC arterial bypass surgery for treatment of complex internal carotid arterial aneurysms were analyzed retrospectively. High-, mid-and low-flow bypass surgeries were performed in 3, 6 and 7 patients, respectively. The postoperative complications and the follow-up digital subtraction angiography （DSA） of the patients were observed. The results of the various operative methods and the postoperative complications were analyzed.Results EC-IC arterial bypass surgery was performed in 16 the patients at Xuanwu Hospital from 2003 to 2008. Among them, 3 had the high-flow bypass surgery, and one of them had hemiplegia and great saphenous vein thrombosis after the procedure. The thrombus were extracted immediately, and his hemiplegia recovered completely one month later. One patient had intracerebral hemorrhage because of hyperperfusion, and his symptom was relieved after decompressive craniectomy, 6 patients accepted mid-flow bypass surgery, 2 of them occurred different degrees of cerebral infarction, aphasia and hemiplegia, and their symptoms were improved after hypervolumic and rehabilitation therapy, 7 patients had low-flow bypass surgery, 4 of them occurred different degrees of hemiplegia after operation, and their symptoms were also improved after hypervolumic and rehabilitation therapy. All the patients were reexamined by DSA one to two weeks after operation, it showed that the parent arteries of the aneurysms were all occluded completely. All but one the the bypass blood vessels were patent, the distal vessels filled well, and no aneurysm was visibled on angiography. 16 patients were followed up for （mean） 3.5 years, no aneurysm recurred or rupturel during the follow-up period.Conclusions EC-IC arterial bypass surgery is an effective means for the treatment of

关 键 词：动脉瘤 颈内动脉 手术后并发症 颅内-外动脉旁路移植术 

分 类 号：R743.35[医药卫生—神经病学与精神病学]