颅内破裂囊状动脉瘤的血管内治疗  

Endovascular treatment of ruptured saccular intracranial aneurysms

作　　者：万军[1,2] 张晓龙[3] 鲁刚[3] 耿道颖[3] 顾伟瑾[1,2] 张磊[1,2] 胡宙[3] 洪泳[3] 何俊[3] 马春英[3] 纪莉华[1,2] 

机构地区：[1]上海市静安区中心医院 [2]复旦大学附属华山医院静安分院介入科,200040 [3]复旦大学附属华山医院放射科

出　　处：《介入放射学杂志》2010年第11期847-851,共5页Journal of Interventional Radiology

摘　　要：目的探讨颅内破裂囊状动脉瘤的血管内治疗的价值和技术。方法回顾性分析上海市静安区中心医院和上海华山医院2004年7月-2008年5月,因自发性颅内出血患者就诊,经全脑DSA检查,确诊颅内囊状动脉瘤138例患者,共149枚动脉瘤。(剔除<2mm的微小动脉瘤患者);并行血管内栓塞治疗。结果本组128枚(86%)囊性动脉瘤完全栓塞;12枚(8%)95%栓塞;9枚(6%)栓塞小于95%,其中4个为宽颈动脉瘤,5个为宽颈大动脉瘤。138例患者中93例(67.4%)患者进行了全脑血管造影随访,DSA随访从6～36个月,平均16.8个月。其中4例(4.3%)复发,但均无再次破裂出血发生。结论颅内囊性动脉瘤血管内治疗并中期随访提示颅内破裂囊性动脉瘤介入治疗是一种安全、有效的治疗方法;破裂囊性动脉瘤栓塞的重点是栓塞瘤颈和载瘤动脉相邻的真性动脉瘤,远端如形成动脉瘤囊泡或假囊,栓塞时无需栓塞或致密栓塞。长期效果有待进一步随访。Objective To discuss the technical points and therapeutic value of endovascular intervention for the treatment of ruptured saccular intracranial aneurysms.Methods During the period of July 2004-May 2008,a total of 138 patients with DSA-proved saccular intracranial aneurysms were encountered in the Affiliated Huashan Hospital of Fudan University and in the Central Hospital of Shanghai Jing＇an District.All the patients had spontaneous subarachnoid hemorrhage and a total of 149 intracranial aneurysms were detected on DSA.Endovascular embolization therapy was carried out in all patients.The mid-term results were analyzed and the technical points were discussed.Results Of the total 149 saccular intracranial aneurysms,total occlusion was achieved in 128 （86%）,subtotal occlusion （ 95%） in 12 （8%）,and partial occlusion （ 95%） in 9 （6%）,which included 4 wide-necked aneurysms and 5 giant aneurysms with wide-neck.A follow-up observation lasting 6-36 months （mean 16.8 months） with DSA was conducted in 93 patients,the results showed that only 4 cases （4.3%） had a recurrence,nevertheless no rupture of the aneurysms occurred again.Conclusion The results of mid-term follow-up indicate that endovascular coil embolization is a safe and effective treatment for ruptured saccular intracranial aneurysms.The technical point is to occlude the aneurismal neck and the true-aneurysm cavity completely.

关 键 词：颅内破裂动脉瘤 血管内栓塞 介入治疗 

分 类 号：R651.1[医药卫生—外科学]