内镜在后交通动脉瘤急性期手术中的应用  

Application of endoscope in the surgery for posterior communicating artery aneurysms in the acute phase

作　　者：顾进茂 黄承光[1] 陈亚坤[1] 齐向前[1] 吕立权[1] 韩凯伟[1] 王君玉[1] 侯立军[1] 

机构地区：[1]第二军医大学附属长征医院神经外科 上海市神经外科研究所 中国人民解放军神经外科研究所,上海200003

出　　处：《中国微侵袭神经外科杂志》2015年第11期481-483,共3页Chinese Journal of Minimally Invasive Neurosurgery

基　　金：国家自然科学基金(编号:81171130)

摘　　要：目的探讨后交通动脉瘤破裂急性期内镜辅助下手术的疗效。方法回顾性分析20例后交通动脉瘤病人的临床资料。均采用翼点入路,显微镜下夹闭动脉瘤,以内镜辅助观察,重点观察隐藏于颈内动脉深面或下壁的重要结构。并分别在颈内动脉前外侧区域（Ⅰ区）、内侧区域（Ⅱ区）和后外侧区域（Ⅲ区）进行观察。结果三个区域在空间大小、观察的内容各有不同的特点。夹闭前内镜探查15例,夹闭后内镜探查20例。5例病例内镜观察后进行动脉瘤夹的调整。均未发生与内镜操作有关的并发症。随访1-2年,GOS 5分18例,4分2例。结论内镜辅助在后交通动脉瘤手术中的应用对降低手术并发症有重要意义。Objective To explore the therapeutic efficacy of endoscopic-assisted clipping for ruptured posterior communicating artery aneurysms in the acute phase. Methods Clinical data of 20 patients with ruptured posterior communicating artery aneurysms were analyzed retrospectively. Pterional approach was used and aneurysms were clipped under microscope with the assistance of endoscope.Endoscopic observation focused on important structures hidden in deep or lower wall of the internal carotid artery. And anterolateral area（district Ⅰ）, inner area（district Ⅱ） and the posterolateral area（district Ⅲ） in the internal carotid artery were observed separately.Results There were different characteristics in the content and space size between the three regions. Endoscopic exploration was performed on 15 patients before the clipping and on 20 after the clipping. The aneurysm clips were adjusted in 5 patients after the endoscopic observation. No endoscopic procedure-related complications occurred. All the patients were followed up for 1 to 2 years,and GOS 5 points in 18 patients and 4 in 2. Conclusion Application of endoscope in the surgery for posterior communicating artery aneurysms is important for reducing the surgical complications.

关 键 词：颅内动脉瘤 后交通动脉 动脉瘤 破裂 神经内镜 夹闭术 

分 类 号：R651.1[医药卫生—外科学]