破裂前交通动脉瘤的个体化介入栓塞治疗  

Individualized interventional embolization of ruptured anterior communicating artery aneurysms

作　　者：高歌[1] 余舰[1] 张扬 晁迎九[1] 陈昱[1] 顾大群[1] 钱若兵[1] 魏建军[1] 牛朝诗[1] 傅先明[1] 

机构地区：[1]安徽省立医院神经外科,合肥230001

出　　处：《中华神经医学杂志》2016年第9期928-931,共4页Chinese Journal of Neuromedicine

摘　　要：目的探讨血管内栓塞治疗前交通动脉瘤的疗效和安全性。方法安徽省立医院神经外科自2011年1月至2013年12月行血管内栓塞治疗前交通动脉瘤患者126例，其中单发动脉瘤109例，多发动脉瘤17例；Hunt-Hess分级Ⅰ级22例，Ⅱ级56例，Ⅲ级35例，Ⅳ级13例；回顾性分析患者的临床资料和疗效。结果126患者中单导管弹簧圈栓塞107例，支架辅助栓塞11例，球囊辅助栓塞4例，双导管弹簧圈栓塞4例；成功栓塞123例，其中RaymondⅠ级栓塞98例（79．6％1，RaymondⅡ级栓塞25例（20-4％）。1例患者栓塞术中出血行开颅手术夹闭＋去骨瓣减压术后死亡：1例患者栓塞术中出血家属要求保守治疗后自动出院；1例患者栓塞术中出血行开颅手术夹闭＋去骨瓣减压术后康复出院。随访患者6个月-4年，无再出血病例。结论血管内栓塞治疗前交通动脉瘤疗效较好。个体化治疗，尽早栓塞、术后早期引流血性脑脊液能降低并发症的发生。Objective To summarize the experience of endovascular embolization in ruptured anterior communicating artery aneurysms, and to explore their therapeutic effect and safety. Methods A retrospective study was performed on the clinical data and treatment efficacy of 126 patients with anterior communicating artery aneurysms treated by endovascular embolization in our hospital from January 2011 to December 2013. In them, 109 were single aneurysms and 17 were multiple aneurysms; according to Hunt-Hess classification, grade I was noted in 22, grade II in 56, grade III in 35, and grade IV in 13 patients. Results In these 126 patients, 107 were treated only with coil embolization, 11 with stent assisted embolization, 4 with balloon assisted embolization, and 4 with double micro catheter technique; 123 were treated successfully by endovascular embolization （Raymond grade I in 98 patients [79.6% ] and Raymond grade II in 25 patients [20.4% ]）. One patient died after surgical clipping＋decompressive craniectomy during the embolization; one patient demanded conservative treatment after hemorrhage during operation and discharged after that; one patient was discharged from hospital upon recovery after surgical clipping＋decompressive craniectomy during the embolization. No re-bleeding was noted during the follow up period （6 months to 48 months）. Conclusion Endovascular embolization is effective in the treatment of anterior communicating artery aneurysms, which can reduce the incidence of complications by individual treatment, early embolization, better embolization technique, and early postoperative drainage of cerebrospinal fluid.

关 键 词：前交通动脉瘤 栓塞 介入治疗 

分 类 号：R743[医药卫生—神经病学与精神病学]