大脑中动脉动脉瘤破裂伴脑内血肿的早期手术治疗  

Early surgical treatment of ruptured middle cerebral artery aneurysms associated with intracerebral haematoma

作　　者：陈志[1] 唐卫华[1] 缪洪平[1] 吴南[1] 朱刚[1] 冯华[1] 

机构地区：[1]第三军医大学西南医院神经外科,全军神经系统疾病微创诊治专科中心,重庆400038

出　　处：《第三军医大学学报》2008年第24期2324-2326,共3页Journal of Third Military Medical University

基　　金："十一五"国家科技支撑计划(2006BAI01A12);the Major Program of the"Eleventh Five-Year Plan"for Sci &Tech Research of China (2006BAI01A12)

摘　　要：目的探讨大脑中动脉动脉瘤破裂合并脑内血肿早期手术的疗效和经验。方法回顾性分析近5年9例大脑中动脉动脉瘤破裂合并脑内血肿患者,早期手术行动脉瘤夹闭及血肿清除术的治疗效果。7例患者术前经常规血管造影或(和)三维CT血管造影(three-dimensional CT angiography,3D-CTA)检查证实,2例患者行CT检查直接手术。术中使用微血管多普勒超声辅助显露动脉瘤及检查动脉瘤夹闭前后载瘤动脉血流。结果 9例患者共10枚动脉瘤均成功夹闭,3个月后随访时GOS评分恢复良好者4例,中度病残2例,重度病残2例,植物生存1例。结论大脑中动脉动脉瘤破裂合并脑内血肿患者病情危重,早期手术能有效改善预后,3D-CTA和术中多普勒超声等无创检查措施能为手术提供帮助。Objective To summarize the experience and effectiveness of early surgical treatment of middle cerebral artery （MCA） aneurysms associated with intracerebral haematoma. Methods Nine patients with ruptured MCA aneurysms associated with intracerebral haematoma, who underwent haematoma evacuation and aneurysmal clipping, were retrospectively reviewed. Preoperative conventional angiography or/and three-dimensional CT angiography （3 D-CTA） was performed in seven patients. Another two patients underwent urgent surgery after CT scanning. Intraoperative Doppler sonography was used to assist exposure of aneurysms and parent vessels before and after aneurysm clipping. Results Ten aneurysms in nine patients were clipped. GOS at three months was good recovery in four cases, moderate disability in two, severe disability in two, and persistant vegetative state in one. Conclusion Acceptable outcome may be achieved in the patients with ruptured MCA aneurysms associated with intracerebral haematoma after early surgery. 3D-CTA and intraoperative Doppler sonography are helpful for surgical treatment.

关 键 词：颅内动脉瘤 大脑中动脉 脑内血肿 显微外科手术 

分 类 号：R651.12[医药卫生—外科学] R739.41[医药卫生—临床医学]