颅内外血管搭桥术治疗前循环巨大动脉瘤  

Efficacy of extracranial-intracranial arterial bypass surgery for giant anterior circulation aneurysms

作　　者：王振宇[1] 黄光富[1] 李志立[1] 谭海斌[1] 唐建[1] 

机构地区：[1]四川省医学科学院.四川省人民医院神经外科,成都610072

出　　处：《中华神经外科杂志》2015年第5期453-457,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨颅内外血管搭桥术治疗前循环巨大动脉瘤的手术方法及疗效.方法 回顾性分析11例2010年3月至2014年6月四川省人民医院采用颅内外血管搭桥手术治疗的前循环巨大动脉瘤患者的临床资料.通过CT血管成像（CTA）和数字减影血管造影（DSA）行血管通畅性评价,探讨移植血管的选择、手术方法及临床效果.结果 采用颈外动脉-大隐静脉-大脑中动脉M2段搭桥7例、颈外动脉-桡动脉-大脑中动脉M2段搭桥2例、颞浅动脉-大脑中动脉M3/M4段搭桥2例.术后9例移植血管通畅,2例移植血管闭塞,血管通畅比例为9/11.1例急诊行颞浅动脉-大脑中动脉搭桥者,术后第3天血管闭塞,术后对侧肢体瘫痪,肌力Ⅲ级.1例术后6个月闭塞,未出现神经功能缺损症状.随访6～51个月,平均18.3个月.术后6个月格拉斯哥预后评分（GOS）：效果良好（4～5分）10例,效果差（3分）1例,无死亡病例.结论 颅内外血管搭桥手术是治疗前循环巨大动脉瘤的安全有效方法,细致的个体化处理方案可提高手术效果.Objective To investigate the surgical methods and efficacy of extracranial-intracranial （EC-IC） arterial bypass surgery for the treatment of giant anterior circulation aneurysms.Methods The clinical data of 11 patients with giant anterior circulation aneurysm treated with EC-IC artery bypass surgery at Sichuan Province People＆#39; s Hospital from March 2010 to June 2014 were analyzed retrospectively.The vascular patency assessment was conducted by CT angiography and digital subtraction angiography （DSA）.The selection of graft vessels,surgical methods,and clinical effect were investigated.Results Seven patients used external carotid artery-great saphenous vein-middle cerebral artery M2 segment bypass,2 used external carotid artery-radial artery-middle cerebral artery M2 segment bypass,and 2 used superficial temporal arterymiddle cerebral artery M4 segment bypass.The grafted vessels were patent in 9 cases after procedure;the grafted vessels were occluded in 2 cases,and the proportion of vascular patency was 9：11.One patient performed emergency superficial temporal artery-middle cerebral artery bypass,his blood vessel was occluded at day 3 after procedure.His contralateral limb was paralyzed after surgery and his muscle strength？ was grade Ⅲ.One patient had vascular occlusion？ at 6 months after surgery,？ and he did not have any symptoms of nerve？ function？ defect.The follow-up period ranged from 6 months to 51 months （mean 18.3 months）.The Glasgow outcome scale scores at 6 months after surgery：10 patients were good （4-5）,1 was poor （3）,and no patients died.Conclusions EC-IC arterial bypass surgery is a safe and effective method for the treatment of giant anterior circulation aneurysms.The detailed and individualized treatment scheme may improve the surgical results.

关 键 词：颅内动脉瘤 脑血管重建术 前循环 

分 类 号：R651.1[医药卫生—外科学]