颈内动脉、椎动脉医源性假性动脉瘤及其处理  

Management of patients with iatrogenic pseudoaneurysm of carotid and vertebral artery

作　　者：周景义[1] 虞军[1] 陈盛[1] 吴群[1] 许璟[1] 张建民[1] 

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州310009

出　　处：《中华医学杂志》2010年第33期2338-2341,共4页National Medical Journal of China

摘　　要：目的探讨颈内动脉、椎动脉医源性假性动脉瘤的形成原因、预防及其处理。方法总结2004年4月至2009年2月浙江大学医学院附属第二医院神经外科4例颈内动脉、椎动脉医源性假性动脉瘤，其中1例为鼻咽癌放射治疗后，其余3例均为手术创伤所致。2例用球囊闭塞假性动脉瘤和载瘤动脉，另2例采用带膜支架闭塞假性动脉瘤并保持载瘤动脉通畅。结果1例颈内动脉假性动脉瘤患者球囊闭塞载瘤血管后出现失代偿，经开颅去骨瓣减压术后遗留长期肢体偏瘫，1例椎动脉假性动脉瘤球囊闭塞后效果良好，2例颈内动脉假性动脉瘤采用带膜支架闭塞了假性动脉瘤并保持载瘤动脉通畅。随访15个月至6年，效果满意。结论对颈内动脉、椎动脉医源性假性动脉瘤应引起足够的重视，对邻近特别是包绕这些动脉时，应仔细操作。对疑似假性动脉瘤患者应及时行脑血管造影，以明确诊断。带膜支架是颈内动脉、椎动脉假性动脉瘤的首选治疗方法。Objective To evaluate the formation mechanism and management of iatrogenic pseudoaneurysms of carotid and vertebral artery. Methods Four patients with iatrogenic pseudoaneurysms were identified at our department from April 2004 to February 2009 . One was caused by radiotherapy and the others due to surgical trauma. Two parents were treated with balloon occlusion of parent artery. Stem grafts were deployed in the other two patients to ensure the pateney of parent arteries and occlusion of pseudoaneurysm. Results One patient with pseudoaneurysm of internal carotid artery developed decompensation after balloon occlusion. Unfortunately, long-term paralysis occurred after decompressive craniectomy. The other patients with vertebral artery pseudoaneurysm achieved an excellent outcome after balloon occlusion. The therapeutic effect of stent grafts in two internal carotid artery pseudoaneurysms was achieved. No recurrence was found during a post-operative follow-up of 15 months to 6 years. Conclusion Iatrogenic pseudoaneurysms of carotid and vertebral artery deserve a priority attention. Cerebrovaseular angiography should be performed if needed. The neurosurgical intervention for iatrogenic pseudoaneurysms may yield an excellent outcome.

关 键 词：医源性疾病 假性动脉瘤 血管内治疗 

分 类 号：R654.3[医药卫生—外科学]