显微手术治疗破裂大脑中动脉动脉瘤  

Microsurgery Treatment of Ruptured Middle Cerebral Artery Aneurysms

作　　者：毛珂[1] 李进[1] 贺民[1] 游潮[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041

出　　处：《华西医学》2012年第5期673-676,共4页West China Medical Journal

摘　　要：目的探讨显微手术治疗破裂大脑中动脉动脉瘤(MCAA)的适应证、术前评估及手术技巧。方法回顾性分析2008年1月-2011年1月经翼点入路行显微外科手术治疗的65例破裂MCAA患者的临床资料。其中男40例,女25例;年龄22～78岁,平均46.8岁。术前Hunt-Hess分级:Ⅰ级15例,Ⅱ级25例,Ⅲ级13例,Ⅳ级10例,Ⅴ级2例。动脉瘤直径<5 mm 10个,5～15 mm 36个,15～25 mm 15个,>25 mm 4个,平均7.8 mm。其中56例动脉瘤位于大脑中动脉分叉部,5例位于大脑中动脉的M1段,4例位于分叉后M2段。结果手术夹闭动脉瘤60例,余5例行动脉瘤夹闭加包裹术。患者术后获随访3～36个月,平均16个月,均无动脉瘤复发或再出血发生。按格拉斯哥预后评分(GOS)结果评定:恢复良好58例(GOS 4～5分),差5例(GOS 2～3分),死亡2例(GOS 1分)。结论充分的术前评估,合适的手术入路选择,以及手术技巧的灵活应用是显微外科手术成功治疗破裂MCAA的保证。Objective To summarize the experiences in treating ruptured middle cerebral artery aneurysms （MCAAs） by microsurgery, and explore the surgical indications, preoperative evaluation as well as operation skills. Methods The clinical data of 65 patients with ruptured MCAAs treated by microsurgery from January 2008 to January 2011 were analyzed retrospectively. Among them, there were 40 males and 25 females aged from 22 to 78 years averaging at 46.8 years. According to pre-operative Hunt-Hess classification, there were 15 cases of grade I, 25 of grade 11 , 13 of grade Ⅲ, 10 of grade IV, and 2 of gradeV. The diameter of aneurysms was shorter than 5 mm in 10 cases, between 5 and 15 mm in 36 cases, between 15 and 25 mm in 15 cases, and longer than 25 mm in 4 cases, averaging at 7.8 ram. Among them, aneurysms in 56 cases were located at the Bifurcation of the MCAAs, 5 cases were located at the M1 segment of MCAAs and 4 cases were located at the M2 segment of MCAAs. Results Aneurysms were successfully clipped in 60 patients, and aneurysms were clipped and wrapped in 5 cases. According to Glasgow outcome scale, the curative effects were good in 58 cases, poor in 3 cases, and 2 patients died. No regrowth or rebleeding occurred during a follow-up from 3 to 36 months in 63 survivors. Conclusion Sufficient preoperative assessment, optimal operative approaches and flexible application of operation skills underlie the successful microsurgical treatment of ruptured middle cerebral artery ancurysms.

关 键 词：大脑中动脉动脉瘤 翼点入路 显微外科 

分 类 号：R651.1[医药卫生—外科学]