术中DSA在颅内复杂动脉瘤夹闭术中的应用  

Application of intraoperative cerebral angiography to neurosurgery for cerebral aneurysms

作　　者：唐爽[1] 曾春[1] 康东[2] TANG Shuang KANG Dong ZENG Chun(Department of Neurosurgery, Suining City Central Hospital, Suining 62900, China Department of Neurosurgery, The Third People ＇s Hospital of Suining City, Suining 62900, China)

机构地区：[1]遂宁市中心医院神经外科,四川629000 [2]遂宁市第三人民医院神经外科,四川629000

出　　处：《中国临床神经外科杂志》2017年第2期77-79,共3页Chinese Journal of Clinical Neurosurgery

基　　金：四川省遂宁市基金项目

摘　　要：目的评价术中DSA在颅内复杂动脉瘤夹闭术中的应用价值。方法回顾性分析20014年1月至2015年10月收治的26例经DSA或CTA确诊的颅内复杂动脉瘤的临床资料,利用复合手术平台在夹闭术中进行DSA检查。结果 26例手术时间为4.3~5.8 h,平均(4.9±0.8)h;术中造影时间为12~45 min,平均(26±11)min。术中DSA证实23例动脉瘤夹闭满意,发现动脉瘤夹闭不全2例,误夹闭后交通动脉1例,调整或补夹动脉瘤夹后再次造影显示动脉瘤均夹闭完全,误夹闭血管显影良好。术后无死亡病例。术后出现偏瘫1例,运动性失语1例,术后发生造影相关并发症(右侧股动脉穿刺处出血)1例。出院时,改良Rankin量表(m RS)评分0~2分23例(88.5%),3~5分1例(11.5%)。21例术后随访6个月,18例m RS评分0~2分,3例3~5分。结论术中DSA在颅内复杂动脉瘤夹闭过程中可及时发现动脉瘤残余、载瘤动脉闭塞,通过及时修正可避免术后严重并发症的发生。Objective To explore the value of intraoperative cerebral angiography to neurosurgery for the cerebral aneurysms. Methods The clinical data of 26 patients with cerebral aneurysms undergoing neurosurgery from January, 2014 to October, 2015 were analyzed respectively. The cerebral aneurysms were definitely diagnosed by DSA or CTA in all the patients in whom intraoperative angiography were performed in the hybridization operating room. Results The intraoperative angiography after the clipping of the aneurysms showed that of 26 patient, 23 received total occlusion of the aneurysms, 2 had aneurismal residue and 1 who underwent mistakenly clipping of the posterior communicating artery received total occlusion of the aneurysms and had the free posterior communicating artery which had been mistakenly clipped after the adjustment of the aneurismal clip. Of 26 patients, 23 were recovered well, 1 had partial hemiplegia, 1 motor aphasia and 1 bleeding in the punctured femoral artery. No patients died. Conclusion The intraoperative angiography can detect unexpected residual aneurysms and parental artery occlusion, and can decrease complications of eerebrovaseular surgery in the patients with cerebral aneurysms.

关 键 词：颅内复杂动脉瘤 术中DSA 夹闭术 应用价值 

分 类 号：R743.9[医药卫生—神经病学与精神病学] R651.12[医药卫生—临床医学]