微型反光镜在颅内动脉瘤夹闭术中的应用  

Application of micro-mirror in microsurgical clipping to the intracranial aneurysm

作　　者：赵超 丰育功[2] 杨允学[1] 张玉海 胡庆雷 付莛凯 史荣华 王艳平[3] 杨永林[1] Zhao Chao;Feng Yugong;Yang Yunxue;Zhang Yuhai;Hu Qinglei;Fu Tingkai;Shi Ronghua;Wang Yanping;Yang Yonglin(Department of Neurosurgery,the Affiliated Rizhao People's Hospital of Jining Medical University,Rizhao 276800,China;Department of Neurosurgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Wulian Road Community Health Service Center of Rizhao People's Hospital,Rizhao 276800,China)

机构地区：[1]济宁医学院附属日照市人民医院神经外科,276800 [2]青岛大学附属医院神经外科,266000 [3]山东省日照市人民医院五莲路社区卫生服务中心,276800

出　　处：《中国医师杂志》2019年第10期1486-1489,1494,共5页Journal of Chinese Physician

基　　金：济宁医学院教师科研扶持基金(JYFC2018FKJ144)~~

摘　　要：目的探讨微型反光镜在颅内动脉瘤夹闭术中的作用,分析其优点和缺点。方法应用微型反光镜辅助显微镜行31例颅内动脉瘤夹闭手术,共夹闭36个颅内动脉瘤,其中颈内动脉眼段动脉瘤3个,脉络膜前动脉瘤3个,后交通动脉瘤11个,大脑中动脉瘤7个,大脑前/前交通动脉瘤10个,大脑后动脉瘤1个,小脑后下动脉瘤1个。通过反光镜仔细观察在显微镜下不易看到的动脉瘤颈周围解剖结构。在显微镜下夹闭动脉瘤后,多角度观察是否存在漏夹或误夹情况,术中结合吲哚菁绿血管荧光造影进一步证实夹闭效果。结果所有动脉瘤均成功夹闭,26例患者术中临时阻断载瘤动脉,9例术中动脉瘤破裂出血,术后随访2周至1年,10例行数字减影脑血管造影(DSA)检查,21例CT脑血管造影(CTA)检查,均未见动脉瘤残留或载瘤动脉闭塞。结论微型反光镜辅助显微镜行动脉瘤夹闭术有助于精准夹闭动脉瘤,操作简便、实用。Objective To explore the value and disadvantage of micro-mirror in the intracranial aneurysm surgery.Methods Micro-mirror was used to assist microsurgical clipping to 36 intracranial aneurysms in 31 cases,of which 3 were carotid-ophthalmic artery aneurysms,3 anterior choroidal artery aneurysm,11 were posterior communicating artery aneurysms,7 were middle cerebral artery aneurysms,10 anterior communicating artery or anterior cerebral artery aneurysms,and the others were a posterior cerebral artery aneurysm and a posterior inferior cerebellar artery aneurysm.The micro-mirror was used before and after clipping to observe the anatomic features of necks hidden behind and medial to aneurysms,to visualize surrounding neurovascular structures,and to verify the optimal clipping position.Intraoperative indocyanine green fluorescein angiography confirmed the success of sufficient clipping.Results All aneurysms were clipped successfully.The parent arteries were occluded temporarily in 26 cases,and 9 aneurysms ruptured during the operation.Postoperative follow-up lasted from 2 weeks to 1 year.After operations digital subtraction angiography(DSA)were repeated in 10 cases,computed tomography angiography(CTA)in 21 cases,and no insufficient clipping or occlusion of parent arteries were revealed.Conclusions Micro-mirror assisting microsurgical clipping to the intracranial aneurysm is conducive to accurate clipping,and is a convenient and practical operation.

关 键 词：颅内动脉瘤 显微外科手术 外科器械 

分 类 号：R74[医药卫生—神经病学与精神病学]