覆膜支架治疗颅颈段动脉瘤的近期结果  

Treatment of cranial-cervical aneurysms with stent-graft： 20 cases report with short-term follow-up

作　　者：张涛[1] 邓剑平[1] 陈虎[1] 刘宇峰[1] 王芳芳[1] 李帅[1] 刘福德[1] 赵振伟[1] 

机构地区：[1]第四军医大学唐都医院神经外科,西安710038

出　　处：《中华外科杂志》2016年第5期346-351,共6页Chinese Journal of Surgery

摘　　要：目的探讨覆膜支架治疗颅颈段动脉瘤的疗效。方法回顾性分析2006年11月至2015年11月在第四军医大学唐都医院神经外科接受覆膜支架治疗的20例颅颈段动脉瘤患者的临床资料，男性15例，女性5例；年龄22～67岁，平均年龄40岁。动脉瘤诱因自发性10例、外伤史5例、手术史5例。术后进行电话、CT血管造影或数字减影血管造影随访，评估治疗效果。结果20例患者共置入24枚覆膜支架，均顺利释放至载瘤动脉。术中支架贴壁不良发生内漏3例，支架远端覆盖不全2例，急性血栓形成1例，病变血管撕裂1例；通过套装支架、弹簧圈栓塞、动脉溶栓等操作后影像学治愈18例，改善2例。术后患者临床症状均得到不同程度改善，随访时间1～96个月，平均19个月，其中2例发生迟发性载瘤动脉闭塞，1例仍存在内漏。结论应用覆膜支架治疗颅颈段动脉瘤安全有效，近期随访结果满意。Objective To investigate the therapeutic effect of cranial-cervical aneurysms with stent- graft. Methods Clinical data of 20 patients with cranial-cervical aneurysm treated with stent-graft in Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University from November 2006 to November 2015 were retrospectively analyzed. There were 15 male and 5 female patients with a mean age of 40 years （ranging from 22 to 67 years）. There were l0 spontaneous cases, 5 trauma history cases and 5 surgery history cases. Postoperative follow-up were made by telephone, CT angiography or digital subtraction angiography, evaluating therapeutic effect. Results Twenty-four stent-grafts placement were carried out in 20 patients and all of them were successfully deployed in the parent artery. Intraoperative stent malapposition induced endoleak occurred in 3 cases, incomplete coverage of distal stent segment in 2 cases, acute thrombosis in 1 case and vessel lesion in l case. Eighteen cases were radiographically cured while the other 2 cases improved through additional stent placement, coil embolization or artery thrombolysis. Clinical symptoms of post-operative patients were improved to varying degrees. Follow-up of 1 to 96 months （ average of 19 months ） were accomplished. Delayed parent artery occlusion were encountered in 2 cases while endoleak still existed in 1 case. Conclusion Application of stent-graft for cranial-cervical aneurysms is safe and effective and the short-term follow-up results are satisfied.

关 键 词：颅内动脉瘤 血管内手术 支架 

分 类 号：R651.12[医药卫生—外科学]