支架辅助弹簧圈栓塞颅内破裂动脉瘤并发症  

The Clinical Analysis on Complication of Stent-assisted Coiling in Ruptured Cerebral Aneurysms

作　　者：傅西安[1] 钱苏荣[1] 王剑刃[1] 林荔青[1] 桑春生 潘耀华[2] 蒲军[3] FU Xi-an;QIAN Su-rong;WANG Jian-ren;LIN Li-qing;SANG Chun-sheng;PAN Yao-hua;PU Jun(Dept.of Neurosurgery,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou Jiangsu 215008;Renji Hospital of Shanghai Jiaotong University School of Medicine,Shanghai 200127;Dept.of Neurosurgery,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]南京医科大学附属苏州医院神经外科,江苏苏州215008 [2]上海交通大学附属仁济医院神经外科,上海200127 [3]昆明医科大学第二附属医院神经外科,云南昆明650101

出　　处：《昆明医科大学学报》2018年第1期50-54,共5页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81360126;81460174);云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2015FB060);南京医科大学科技发展基金资助项目(2016NJMU152);苏州市民生科技-医疗卫生应用基础研究基金资助项目(SYSD2016121)

摘　　要：目的回顾性分析支架辅助弹簧圈栓塞颅内复杂动脉瘤的并发症发生率,探讨并发症发生的原因及治疗方法.方法蛛网膜下腔出血患者行支架辅助弹簧圈栓塞动脉瘤62例,单发动脉瘤53例,多发动脉瘤9例(2个动脉瘤8例,3个动脉瘤1例),共计72个动脉瘤,除1例外,均行支架辅助动脉瘤栓塞治疗.结果完全填塞53个(74.64%),近全填塞17个(23.94%),部分填塞1个(1.42%).根据GOS预后评分,GOS5分52例,GOS 4分6例,GOS 3分3例,GOS 2分1例.预后良好的患者(GOS 4~5分)58例(93.5%).并发症发生率为14.5%,其中急性血栓形成3例;栓塞过程中动脉瘤破裂2例;术中脑血管痉挛3例;术中造影未见明显异常,术后有局灶性缺血性改变并伴轻度神经功能缺失1例.结论支架辅助弹簧圈栓塞治疗颅内破裂动脉瘤是安全有效、切实可行的,但应当在临床操作中提高临床技能、总结分析临床处理经验来降低并发症的发生,并发症发生后的及时、正确处理亦相当重要.Objective To retrospectively analyze the postoperative morbidity of patients with complex intracranial aneurysms treated by stent-assisted coiling and investigate the causes and treatment strategy of postoperative morbidity.Methods 62 SAH patients with intracranial aneurysm were treated by stent-assisted coiling,53 cases of single aneurysms,9 cases of multi-aneurysms(8 cases of 2 aneurysms,1 cases of 3 aneurysms),amount to 72 aneurysms,71 aneurysms were treated by stent-assisted coiling.Results Completed embolization 53 cases were completed with embolization partial embolization(74.64%),Nearly all embolization 17 cases were nearly all embolization(23.94%),partial embolization and 1case was s(1.42%).According to GOS,52 patients with a score of GOS 5,6 patients with a score of GOS 4,3 patients with a score of GOS 3,2 patients with a score of GOS 1.58(93.5%)patients survived favorably.9 patients with complications(14.5%),3 patients with acute thrombosis;2 patients with rupture of aneurysms during surgery;3 patients with cerebral angiospasm;There was no obvious abnormality during the surgery in 1 patient,and there was a focal ischemic change followed by a mild neurological deficiency.Conclusions Stent assisted coil embolization of intracranial ruptured aneurysmis safe,effective and feasible,but we should improve clinical skills,summarize the analysis in the clinical operation experience of clinical treatment so as to reduce complications.Timely and correct treatment is also very important when complications occur.

关 键 词：蛛网膜下腔出血 动脉瘤 血管内治疗 

分 类 号：R743.35[医药卫生—神经病学与精神病学]