血流调整及血流重建治疗颈内动脉海绵窦段巨大型动脉瘤的临床分析  

Clinical analysis of blood flow alteration and revascularization in the treatment of giant cavernous carotid aneurysms

作　　者：李唐[1,2] 孙杨[1] 杨建华 张文超 施铭岗[1] 尚彦国 佟小光[1] Li Tang;Sun Yang;Yang Jianhua;Zhang Wenchao;Shi Minggang;Shang Yanguo;Tong Xiaoguang(Clinical College of Neurology,Neurosurgery and Neurorehabiliation,Tianjin Medical University,Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China;Department of Neurosurgery,the First Afiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]天津医科大学神经内外科及神经康复临床学院,天津市环湖医院神经外科,天津300350 [2]广西医科大学第一附属医院神经外科,南宁530021

出　　处：《中华神经外科杂志》2022年第4期388-393,共6页Chinese Journal of Neurosurgery

基　　金：天津市科委重大专项(18ZXDBSY00180)。

摘　　要：目的探讨血流调整及血流重建治疗症状性颈内动脉海绵窦段巨大型动脉瘤的手术方法及临床疗效。方法回顾性分析2012年3月至2019年8月天津市环湖医院神经外科收治的20例症状性颈内动脉海绵窦段巨大型动脉瘤(最大直径≥2.5 cm)患者(共20个动脉瘤)的临床资料。术前行头颅CT血管成像(CTA)、数字减影血管造影(DSA)、球囊闭塞试验、脑灌注成像并综合评估后选择相应的手术治疗方案。20例患者中,接受单纯颈内动脉结扎术2例,单纯颈内动脉缩窄术11例,高流量搭桥联合颈内动脉结扎术2例,中流量搭桥联合颈内动脉结扎术1例,低流量搭桥联合颈内动脉缩窄术4例。术后定期随访并复查头颅CTA或DSA,采用改良Rankin量表评分(mRS)评估患者的预后。结果20例患者中,术后动脉瘤消失5例,体积缩小11例,大小无变化4例。术后3例患者出现局灶性脑梗死。18例获得随访,2例失访。影像学随访时间为(7.8±3.0)个月(3~12个月),其中动脉瘤消失7例,体积缩小9例,大小无变化2例。临床随访时间为(46.3±16.3)个月(20~85个月),至末次随访,16例患者的术前症状消失或好转,2例症状无改善。末次随访mRS:0分9例,1分8例,3分1例。结论血流调整联合血流重建是治疗症状性颈内动脉海绵窦段巨大型动脉瘤的有效方法。根据患者的侧支循环代偿情况采取个体化手术方案,能够获得较好的预后,且并发症少。Objective To explore the surgical strategy and clinical effect of blood flow alteration and revascularization in the treatment of giant cavernous carotid aneurysms.Methods A retrospective analysis was conducted on the clinical data of 20 patients(20 aneurysms in total)with symptomatic giant cavernous carotid aneurysms(diameter≥2.5 cm)who were admitted to the Department of Neurosurgery of Tianjin Huanhu Hospital from March 2012 to August 2019.Head CT angiography(CTA),digital subtraction angiography(DSA),blloon occlusion test and cerebral perfusion imaging were performed and comprehensively evaluated preoperatively.Individualized surgical strategy was designed based on comprehensive preoperative assessment.Among the 20 patients,2 underwent internal carotid artery(ICA)ligation,11 underwent ICA constriction,2 underwent high flow bypass combined with ICA ligation,1 underwent medium flow bypass combined with ICA ligation,and 4 underwent low flow bypass combined with ICA constriction.The patients.were followed up regularly for CTA or DSA after surgery,and the outcomes were evaluated based on the.modified Rankin scale(mRS).Results The aneurysms disappeared in 5 cases,decreased in size in 11 cases and remained unchanged in size in 4 cases.Three patients developed focal cerebral infarction postoperatively.18 cases were followved up,and 2 cases were lost to follow-up.The imaging follow-up time was 7.8±3.0 months(range:3-12 months),and the aneurysms disappeared in 7 cases,shrunk in 9 cases,and had no change in size in2 cases.At the fllow-up for an average of 46.3±16.3 months(20 to 85 months),16 patients'symptoms disappeared or relieved,and 2 patients did not have relief.The mRS score at the last fllow-up were 0 in 9 cases,1in8casesand3in1case.Conclusions Flow alteration coupled with revascularization is an effective method for the treatment of symptomatic giant cavermous carotid aneurysms.Individualized surgical strategy based on the status of collateral circulation can achieve a good prognosis with few complications.

关 键 词：颅内动脉瘤 治疗结果 血流调整 血流重建 颈内动脉海绵窦段动脉瘤 巨大 

分 类 号：R651.1[医药卫生—外科学]