症状性颈动脉狭窄合并同侧未破裂动脉瘤的手术治疗  

Surgical treatment for symptomatic carotid artery stenosis with ipsilateral unruptured aneurysms

作　　者：田剑光[1] 曹旭华[1] 李琛[1] 贾亮[1] 马志昭[1] 张皓峰[1] 王立群[1] TIAN Jian-guang;CAO Xv-hua;LI Chen;JIA Liang;MA Zhi-zhao;ZHANG Hao-feng;WANG Li-qun(Department of Neurosurgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, China)

机构地区：[1]河北医科大学第二医院神经外科,石家庄050000

出　　处：《脑与神经疾病杂志》2017年第3期179-182,共4页Journal of Brain and Nervous Diseases

摘　　要：目的探讨颈动脉狭窄合并颅内未破裂动脉瘤患者的手术治疗。方法分析2015年2例1期行动脉瘤夹闭+颈动脉内膜剥脱术(CEA)的症状性颈动脉狭窄合并同侧未破裂的颅内动脉瘤患者的临床资料。结果该两例患者均先行颅内动脉瘤夹闭术,然后1期行CEA。术后患者症状消失,复查头颈上胸段CTA,可见动脉瘤完全夹闭,颈动脉斑块完全切除,血流通畅,患者痊愈出院。术后3个月随访,两例患者症状消失,复查头颈上胸段CTA颈动脉未见再狭窄。结论颈动脉狭窄合并颅内动脉瘤是一种比较特殊的脑血管疾病,该类患者外科手术治疗过程中的血压控制是手术成功的重要问题,本文选择在电生理监测下先行动脉瘤夹闭,解除由于血压波动导致动脉瘤破裂的危险,然后再行CEA。Objective To explore the surgical treatment of carotid artery stenosis with intracranialunruptured aneurysms.Method Two patients with aneurysm clipping and carotid endarterectomy in symptomaticcarotid artery stenosis combined with unruptured intracranial aneurysm in our hospital were analyzed.Results Bothpatients underwent intracranial aneurysm clipping,and then underwent carotid endarterectomy(CEA).Symptomswere disappeared after surgery,review the head and neck thoracic CTA,aneurysm can be seen closed completely,carotid plaque was completly removed and blood flowing was unobstructed,the patients got well and left the hospital.The follow-up was done3months after operation,two patients'symptoms were disappeared,reviewing the neckand upper thoracic CTA showed that the carotid artery was not strictured.Conclusion Carotid artery stenosiswith intracranial aneurysm is a kind of special cerebrovascular disease.In this kind of patients,blood pressurecontrol during surgical treatment is an important issue for successful operation.We choose aneurysm clipping underelectrophysiological monitoring first to lift the risk of rupture of the aneurysm due to blood pressure fluctuations,andthen undergo the CEA.

关 键 词：颈动脉狭窄 动脉瘤 颈动脉内膜剥脱术 

分 类 号：R743[医药卫生—神经病学与精神病学]