颅内外血管搭桥在大脑中动脉复杂动脉瘤治疗中的应用  

Intracranial-extracranial vascular bypass in the treatment of complex middle cerebral arteryaneurysms

作　　者：刘方军[1] 张永力[1] 孙玉明[1] 林达[1] 周忠清[1] 钱海[1] 石祥恩[1] 

机构地区：[1]北京三博脑科医院(首都医科大学第十一临床医学院神经外科),100093

出　　处：《中华神经外科杂志》2014年第2期109-112,共4页Chinese Journal of Neurosurgery

基　　金：国家临床重点专科建设项目（SG2011-04-01）

摘　　要：目的探讨颅内外（IC-EC）动脉搭桥术治疗复杂大脑中动脉（MCA）动脉瘤的方法及疗效。方法回顾性分析北京三博脑科医院神经外科2008年5月至2012年12月手术治疗的6例复杂MCA动脉瘤的临床资料，2例采用颞浅动脉（STA）-桡动脉（RA）-MCA搭桥术加动脉瘤孤立切除术，4例采用颌内动脉（MA）-RA-MCA搭桥术加动脉瘤近心端阻断术。颅外血管吻合口采用端一端吻合，颅内血管吻合口采用端-侧吻合。结果1例MA-RA-MCA搭桥加动脉瘤近心端阻断患者术后第3天出现偏瘫、脑疝、脑梗死，搭桥血管血栓形成，急诊行减压术及血栓取出，二次术后搭桥血管通畅。其余患者吻合口均通畅。随访3-58个月，恢复良好5例，生活自理1例。结论IC-EC搭桥术加动脉瘤孤立切除或近心端阻断术可以有效地治疗复杂MCA动脉瘤。Objective To explore the methods and effects of intracranial-extracranial （IC-EC） vascular bypass in the treatment of complex middle cerebral artery （MCA） aneurysms. Methods 6 cases with complex MCA aneurysms were treated with operation from May 2008 to December 2012 in our department, the clinical data were analyzed retrospectively. After superficial temporal artery （STA） -radial artery （RA）-MCA bypass grafting was performed, the aneurysms were trapped and resected in 2 cases. After internal maxillary artery （MA） -RA-MCA bypass grafting was performed, the parent artery was occluded in 4 cases. End-to-end anastomosis was used in EC artery. End-to-side anastomosis was used in IC artery. Results Hemiparalysis, cerebral hernia and graft artery thrombosis occurred in one patient who received IMA-RA-MCA bypass the third day after operation. Decompression procedure and thrombosis removed were performed in emergency. The bridge vessel was unobstructed after second operation. All other patients kept patent. Follow-up so far, 5 cases got a good resuh, the rest lived independent life. Conclusions IC-EC vascular bypass grafting followed by trapping aneurysm or parent artery occlusion is an effective approach in the treatment of complex MCA aneurvsms.

关 键 词：颅内动脉瘤 大脑中动脉 颅内外血管搭桥 血管吻合技术 动脉瘤孤立术 

分 类 号：R739.41[医药卫生—肿瘤]