颅内巨大动脉瘤的手术治疗  

Surgical treatment for the giant intracranial aneurysms

作　　者：史继新[1] 王汉东[1] 杭春华[1] 孙克华[1] 潘云曦[1] 谢韡[1] 成惠林[1] 樊友武[1] 刘承基[1] 邬祖良[1] 谭启富[1] 

机构地区：[1]南京军区南京总医院神经外科,210002

出　　处：《江苏医药》2000年第11期840-843,共4页Jiangsu Medical Journal

摘　　要：目的　颅内巨大动脉瘤虽然少见 ,但手术治疗困难 ,手术病死率和致废率仍较高。本文对我院 1980年以来手术治疗的 30例颅内巨大动脉瘤作一回顾性分析。方法　动脉瘤瘤颈夹闭术 13例 ;动脉瘤孤立或孤立后切除术 11例 ;动脉瘤切除或孤立后载瘤动脉重建术 2例 ;颈部颈内动脉结扎术 2例 ;动脉瘤包裹术 2例。结果　术后早期恢复良好者为 73 3 % ,中、重残者为 2 0 % ,死亡2例 ,病死率 6 6 %。动脉瘤瘤颈夹闭组的 13例病人中 ,除 1例术前Ⅳ级的前交通动脉瘤病人术后重残外 ,均恢复顺利。动脉瘤孤立或孤立后切除的 11例病人中 ,4例术后早期出现不同程度的对侧肢体瘫痪 ,其中 2例在术后 3周内恢复正常 ,另 2例分别在术后 3个月和 2 8个月恢复正常 ;1例大脑中动脉 (MCA)动脉瘤术后因术野血肿再次手术清除血肿后 ,病人出院时能独立行走。单纯行颈部颈动脉结扎的 2例病人出院时病情无明显变化。而仅行动脉瘤包裹术的 2例病人均在术后因再出血死亡。结论　为消除巨大动脉瘤的占位效应和出血的潜在性 ,对颅内巨大动脉瘤提倡积极的直接手术治疗。动脉瘤瘤颈直接夹闭并保留载瘤动脉通畅是首选治疗 ,对必需行动脉瘤孤立且交叉循环不良的病例 。Objective The giant intracranial aneurysms are lesions which represent only 3 to 6% of all cerebral aneurysms.Due to the anatomical complexity and the technical difficulty of their surgical management,the mortality and morbidity for these entities remain high.The purpose of this paper is intended to show the results of the retrospective analysis of 30 patients with the giant intracranial aneurysms.Methods Direct clipping of the aneurysms was accomplished in 13 cases,aneurysm trapping or removal after trapping in 11cases,aneurysm excision or trapping with parent artery anastomosis in 2 cases(the end to end anastomosis of the main trunk of middle cerebral artery (MCA) being performed in one with giant aneurysm of MCA,and interposition great saphenous vein grafting between the ICA in the neck and intracranial ICA in the other with the giant transitional cavernous aneurysm),aneurysm wrapping in 2 and the ligation of the carotid artery in the neck were completed in 2 cases.Results Early postoperative neurological function was evaluated using Glasgow Outcome Scale scores.21 patients had an excellent or good outcome,5 patients had moderate disability and 1 patient had severe disability.2 patients with aneurysm wrapping died due to postoperative aneurysm bleeding.All 13 patients with direct clipping of the aneurysms and 2 patients with aneurysm excision or trapping with parent artery reconstruction gained good recovery except for one who had preoperative Ⅳ grade according to Hunt and Hess Grades after SAH and underwent severe disability postoperatively.In 11 patients of the group of the aneurysm trapping or excision after trapping,4 patients experienced contralateral hemiparesis,of which,2 patients had their normal neurological function 3 weeks after operation and

关 键 词：巨大动脉瘤 外科治疗 大隐静脉移植 颅内肿瘤 

分 类 号：R739.410.5[医药卫生—肿瘤] R730.56[医药卫生—临床医学]