动脉瘤栓塞术后复发再次行开颅夹闭的研究  

Microsurgical clipping for recurrent aneurysms after endovascular coil embolization

作　　者：丁正斌[1] 全伟[2] 周向阳[1] 

机构地区：[1]南华大学附属第一临床学院神经外科,衡阳421001 [2]广州市第一人民医院神经外科,510180

出　　处：《中华神经医学杂志》2016年第7期710-712,共3页Chinese Journal of Neuromedicine

摘　　要：目的探讨动脉瘤栓塞术后复发再次行开颅夹闭手术的效果、安全性。方法南华大学附属第一临床学院神经外科自2012年5月至2014年5月共收治动脉瘤栓塞术后复发患者5例，其中前交通动脉瘤3例，后交通动脉瘤2例；栓塞前动脉瘤直径3～10mm，术后数字减影血管造影（DSA）显示动脉瘤都完全栓塞；复发时间0．7～30个月，平均14个月。5例患者均在显微镜下再次行开颅夹闭术。结果5例栓塞术后动脉瘤复发患者经过再次开颅夹闭手术治疗，动脉瘤都完全夹闭，且都未取出弹簧圈。1例患者手术对侧上肢肌力Ⅲ级（术前正常），1例患者术后3个月有精神症状，经口服药物后均基本恢复正常，其他患者无明显并发症；1例患者眼睑下垂后恢复。术后半年、1年行CT血管造影（CTA）复查，未见动脉瘤复发。结论对于栓塞术后复发动脉瘤患者，在不取出栓塞弹簧圈的情况下，行开颅夹闭手术是安全的、有效的。Objective To assess the efficacy, safety and surgical strategies of clipping without coil removal in recurrent aneurysms after previous coil embolization. Methods Five patients with recurrent embolized aneurysms underwent microsurgical treatment in our hospital from May 2012 to July 2014 were chosen. Posterior communicating aneurysms were noted in two patients and anterior communicating ones in three patients. The initial sizes ranged from 3-10 mm in diameter; in these aneurysms, the initial coiling results indicated complete occlusion in 5 patients. The mean recurrence latency was 14 months （ranged from 0.7-30 months）. Surgical treatment without coil removal in recurrent aneurysms was performed and their clinical data and treatment efficacy were retrospectively analyzed. Results Microsurgical clippings without coil removal were used in all 5 patients. No postoperative morbidity was observed （one had left arm monoparesis, one had psychiatric symptoms, and one had blepharoptosis and recovered soon）; postoperative imaging studies revealed complete occlusion of the aneurysms. There were no recurrent aneurysms during the follow-up period （6 and 12 months after surgery） by CT scan. Conclusion The microsurgical clipping without coil removal for recurrent lesions of embolized aneurysms is effective and safe when it is technically feasible.

关 键 词：动脉瘤复发 血管内栓塞 颅内动脉瘤 开颅夹闭 

分 类 号：R651.12[医药卫生—外科学]