大脑中动脉瘤破裂合并颅内血肿的早期显微手术治疗  

Early microsurgery of ruptured middle cerebral artery aneurysm combined with intracerebral hematoma

作　　者：郭致飞[1] 赵兵[1] 吴德俊[1] 李德坤[1] 江涛[1] 王少华[1] 仰鹏志[1] 孙锦章[1] 沈杰[1] 

机构地区：[1]安徽医科大学第二附属医院神经外科安徽医科大学脑血管病研究中心,安徽合肥230601

出　　处：《安徽医药》2016年第8期1521-1524,共4页Anhui Medical and Pharmaceutical Journal

摘　　要：目的：总结伴有颅内血肿的大脑中动脉破裂动脉瘤的早期显微手术技巧和效果。方法回顾性分析18例大脑中动脉瘤破裂合并颅内血肿的患者手术临床资料，总结其手术方法及疗效。结果18例患者全部一期夹闭责任动脉瘤并清除血肿，术后 CT 血管造影（CTA）或数字剪影血管造影（DSA）复查有2例动脉瘤颈残留复发，术后随访3～50月，按格拉斯哥结果量表（GOS）评定预后，恢复良好12例，中残3例，重残2例，死亡1例。结论大脑中动脉瘤破裂合并脑内血肿应积极早期显微手术，对于缓解颅内压，防止动脉瘤再破裂出血，改善预后具有重要意义。运用临时阻断技术，具备娴熟手术技巧，确保载瘤动脉及分支血管的通畅是手术成功关键。Objective To summarize the techniques and effects of early microsurgery of ruptured middle cerebral artery aneurysm com-bined with intracerebral hematoma.Methods The clinical data of 18 patients who underwent microsurgical treatment of ruptured mid-dle cerebral artery aneurysm combined with intracerebral hematoma from were analyzed retrospectively,and their surgical methods and therapeutic effects were summarized.Results Eighteen patients all received stage I surgery with the clipping of ruptured aneurysms and evacuation of hematoma,and 2 cases of patients found with recurring residual cervical aneurysm by postoperative CT angiography （CTA）or digital subtraction angiography （DSA）examinations.Follow-up visits were carried out raging from 3 months to 50 months, and Glasgow Outcome Scale （GOS）was adopted to evaluate the prognosis.Twelve cases got good recovery,3 cases were disabled mod-erately,2 cases were disabled severely,and 1 case died.Conclusions Patients who suffer from ruptured middle cerebral artery aneu-rysm combined with intracerebral hematoma should undergo microsurgery at early stage,which is of great significance to the reduction of intracranial pressure,the prevention from re-rupture of aneurysms as well as the improvement of prognosis.Temporary blocking technolo-gy,skilled surgical techniques as well as patency of the parent artery and its branches are key factors to the success of surgery.

关 键 词：颅内出血 动脉瘤 破裂 大脑中动脉 脑血管重建术 

分 类 号：R651.12[医药卫生—外科学]