DSA杂交手术室“一站式”精准治疗颅内复杂动脉瘤合并脑内血肿  

One-stop procedure in DSA hybrid operating room for treatment of ruptured intracranial complex aneurysms combined with cerebral hematomas

作　　者：张文清[1] 黄绳跃[1] 冯文峰[2] 漆松涛[2] 温玉星[1] 黄为琰 陈忠仪[1] ZHANG Wenqing;HUANG Shengyue;FENG Wenfeng;QI Songtao;WEN Yuxing;HUANG Weiyan;CHEN Zhongyi(Department of Neurosurgery,Fujian Medical University Provincial Clinical Medical College,Fujian Provincial Hospital,Fuzhou 350001,China;Department of Neurosurgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China;College of Integrative Medicine,Fujian University of Traditional Chinese Medical,Fuzhou 350122,China)

机构地区：[1]福建医科大学省立临床学院福建省立医院神经外科,福建福州350001 [2]南方医科大学南方医院神经外科,广东广州510515 [3]福建中医药大学中西医结合学院,福建福州350122

出　　处：《中国介入影像与治疗学》2019年第7期395-399,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：福建省科技计划项目(2016Y0017)

摘　　要：目的探讨DSA杂交手术室"一站式"精准治疗颅内复杂动脉瘤合并脑内血肿的价值。方法对11例颅内复杂动脉瘤合并脑内血肿未发生脑疝患者于发病72h内行DSA杂交手术室"一站式"精准治疗,术中以DSA评估动脉瘤是否累及载瘤动脉,行DSA引导下颅内外血管搭桥联合动脉瘤孤立术或球囊临时阻断辅助下动脉瘤塑形夹闭治疗,同步清除血肿。实时监测术中治疗情况,记录术中及术后并发症。随访观察术后6个月CTA表现;于出院及末次随访时以格拉斯哥转归评分(GOS)评价疗效,GOS≥4分认为治疗效果良好。结果对5例行颞浅动脉(STA)-大脑中动脉(MCA)搭桥,术中DSA示桥血管通畅,一期行动脉瘤孤立术;6例行动脉瘤塑形夹闭,术中3例误夹穿支血管,1例夹闭不全,调整瘤夹位置后夹闭效果满意。术后并发小灶性脑梗死2例,癫痫1例。出院时、末次随访时治疗效果良好患者均占81.82%(9/11)。术后6个月均未见复发,吻合口及载瘤动脉无狭窄。结论对难以直接夹闭或介入栓塞治疗的颅内复杂动脉瘤合并脑内血肿患者,采用DSA杂交手术室"一站式"精准治疗可获得较好效果。Objective To explore the clinical value of one-stop procedure in DSA hybrid operating room for treatment of ruptured intracranial complex aneurysms combined with cerebral hematomas. Methods Eleven patients within 72 h after onset of ruptured intracranial complex aneurysms combined with cerebral hematomas without cerebral hernia underwent one-stop procedure in DSA hybrid operating room.Intraoperative DSA was used to evaluate whether the aneurysm involved the parent artery.The aneurysms were treated with intracranial aneurysm isolation combined with extra-intracranial bypass under the guidance of DSA or temporary balloon occlusion assisted shape clipping.And the hematomas were removal appropriately.Intraoperative situation of hybrid surgery was monitored in real time.Intraoperative and postoperative complications were recorded.The patients were followed up after discharge.CTA examinations were performed 6 months after operation.Glasgow outcome score (GOS) was used to evaluate the efficacy when patients were discharged and the last follow-up.When the scores were equal or greater than 4,the discharge was considered as effective treatment.Results Superficial tempora1 artery (STA)-middle cerebral artery (MCA) bypass were performed in 5 patients smoothly.Intraoperative DSA revealed that the bridge vessel was unobstructed,and the aneurysms were isolated in one stage.Six patients were treated with shape clipping.Mistakenly clipping of perforator vessels occurred in 3 patients,and incomplete clipping occurred in 1 patient.The clamping effect was satisfactory after adjusting the positions of aneurysm clips.There were 2 cases of focal infarction and 1 case of epilepsy after operation.The proportion of patients responded well to treatment was both 81.82%(9/11) when discharged and the last follow-up,respectively.No recurrence,stenosis of anastomotic nor parental artery was detected among 11 patients 6 month after operation.Conclusion Patients with complex aneurysms associated with intracranial hematomas impossible treated with

关 键 词：颅内动脉瘤 颅内出血 血管造影术 数字减影 杂交手术室 

分 类 号：R651.1[医药卫生—外科学] R543.5[医药卫生—临床医学]