Pipeline栓塞装置治疗颅内动脉瘤的初步经验  

Pipeline embolization device for the treatment of intracranial aneurysms： a preliminary experience

作　　者：盖延廷[1] 王威[1] 刘旻谛 李东波[1] 宋冬雷[1] 

机构地区：[1]上海市浦东新区浦南医院神经外科,200125

出　　处：《中华神经外科杂志》2016年第7期691-695,共5页Chinese Journal of Neurosurgery

摘　　要：目的 探讨Pipeline栓塞装置（PED）在颅内动脉瘤中的临床应用价值和技术特点.方法 回顾性分析2014年12月至2015年12月上海浦东新区浦南医院神经外科应用Pipeline栓塞装置治疗的20例颅内动脉瘤患者的临床资料.其中单发动脉瘤15例,多发动脉瘤5例,共28个动脉瘤;直径为2～ 33 mm,平均（15.2±9.9）mm.所有患者均用1枚PED覆盖瘤颈,其中8例结合动脉瘤内弹簧圈栓塞治疗.结果 20例患者全部顺利完成Pipeline栓塞装置的释放,瘤颈覆盖满意,PED贴壁良好,术后即刻显示动脉瘤腔内造影剂明显滞留.3例患者术后出现脑出血并发症,其中1例死亡,1例出院时有轻偏瘫.6个月后数字减影血管造影（DSA）随访8例,其中6例完全治愈,1例动脉瘤近全闭塞,1例大型动脉瘤大小无明显变化;2例出现无症状性大脑前动脉起始部狭窄.头颅MRI随访提示大型、巨大型动脉瘤占位效应明显缓解或消失.其余11例有待随访.结论 PED治疗大型和巨大型颅内动脉瘤、串联多发小动脉瘤、颅内血泡样动脉瘤疗效满意.该装置在国内尚刚开始应用于临床,并发症和远期疗效还需大样本病例分析研究.Objective To investigate the clinical application value and technical characteristics of pipeline embolization device （PED） for the treatment of intracranial aneurysms.Methods From December 2014 to December 2015,the clinical data of 20 patients with intracranial aneurysm treated with PED at the Department of Neurosurgeries,Shanghai Punan Hospital of Pudong New District and Donglei Brain Surgeon Group were analyzed retrospectively.Fifteen patients had one aneurysm and 5 had multiple aneurysms.The diameters of 28 aneurysms were 2-33 mm （15.2 ± 9.9 mm）.The aneurysm necks of all patients were covered with 1 PED,and 8 of them were treated with the combined aneurysm coil embolization.Results The release of PEDs in all 20 patients was completed successfully.The coverage of aneurysm necks was satisfactory.PEDs were found well adhering to the wall.Immediately after surgery,it showed that contrast agents in aneurysm cavities were obviously detained.Three patients had complications of cerebral hemorrhage after procedure,including 1 died and 1 had hemiparesis at discharge.Eight patients were followed up by digital subtraction angiography （DSA） 6 months later,6 were cured completely,the aneurysm of 1 case was nearly completely occluded,and the size of a large aneurysm did not have obvious change.Two patients had asymptomatic anterior cerebral artery stenosis.The head MRI follow-up revealed that the mass effect of the large and giant intracranial aneurysms were significantly relieved or disappeared.The remaining 11 cases had to be followed up.Conclusions The efficacy of PED for the treatment of large and giant intracranial aneurysms,tandem multiple small aneurysms and intracranial blood blister-like aneurysms is satisfactory.This device has just begun to be applied in clinical practice in China.The complications and long-term efficacy of the large sample case analysis and research are needed.

关 键 词：颅内动脉瘤 栓塞 治疗性 Pipeline栓塞装置 

分 类 号：R651.12[医药卫生—外科学]