前交通动脉瘤分型与显微手术治疗技巧分析  

Analysis of the classification and microsurgical technique of the anterior communicating aneurysm

作　　者：谢满意[1] 李中林[1] 朱玉辐[1] 纪培志[1] 苗发安[1] 王子德[1] 

机构地区：[1]徐州医学院附属医院神经外科,江苏徐州221002

出　　处：《徐州医学院学报》2015年第5期321-323,共3页Acta Academiae Medicinae Xuzhou

摘　　要：目的总结不同分型前交通动脉瘤的解剖特点及显微手术技巧，旨在减少术后缺血性并发症。方法回顾性分析35例经显微手术治疗的前交通动脉瘤患者的临床资料，根据动脉瘤体指向将其分为前、上、后、下、复杂指向5种分型。以不同分型前交通动脉瘤解剖特点为基础分析、讨论手术技巧。结果35例前交通动脉瘤中前指向9例，术后无脑梗死病例；上指向13例，术后脑梗死2例；后指向8例，术后脑梗死2例；下指向2例，术后脑梗死1例；复杂指向3例，术后脑梗死1例。术后随访6—12个月，下指向动脉瘤组再出血、再手术1例。结论不同指向前交通动脉瘤解剖特点及手术治疗技巧不同，辨认、保护组成前交通动脉复合体的11支血管，尤其穿支血管的保护是减少术后缺血性并发症的关键。Objective To summarize the anatomic characteristics and surgical technique of the anterior communicating aneurysm with different orientation in order to reduce postoperative ischemic events. Methods After retrospective analysis of 35 microsurgical cases of anterior communicating aneurysm, they were classified into five groups according the projection of aneurysm： anterior type, superior type, posterior type, inferior type, and compound type. Microsurgical technique was discussed from the anatomic perspective. Results None of 9 cases in the anterior group developed ischemic complication postoperatively, and 2 cases of ischemia occured in 13 cases of the superior group. 8 cases were classified in the posterior group and 2 developed cerebral infarction. The inferior group included 2 cases and ischemic event occured in 1 case. 3 cases had compound type and 1 case suffered ischemic impairment. Follow - up of 6 - 12 months showed that 1 case in the compound group rebled and required reoperation. Conclusion Different anatomic relationship are associated with different anterior communicating aneurysm orientation, and specific microsurgical technique are needed. Identification and preservation of the 11 vessels constituting the anterior communicating compound, especially their perforating branches, is vital to avoid the ischemic event.

关 键 词：前交通动脉瘤 分型 显微手术 

分 类 号：R651.12[医药卫生—外科学]