复合手术在床突旁大型复杂动脉瘤夹闭中的应用效果  

Application of hybrid surgery in the clipping of large complex paraclinoid aneurysms

作　　者：谭潇潇 王林 张建民 Tan Xiaoxiao;Wang Lin;Zhang Jianmin(Department of Neurosurgery,the Second Affiliated Hospital of Zhejiang University,School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院神经外科,杭州310009

出　　处：《中华医学杂志》2022年第19期1468-1471,共4页National Medical Journal of China

摘　　要：复合手术条件下对2016年1月至2021年7月浙江大学医学院附属第二医院9例床突旁大型复杂动脉瘤进行夹闭, 采取术中造影对动脉瘤及夹闭效果即时评估。共实施近端球囊临时阻断8例, 其中联合负压抽吸辅助塑形2例。术后2例患者出现症状性脑梗死, 3例出现一过性动眼神经麻痹, 无患者视力下降。术后随访显示1例瘤颈少量残留, 其余动脉瘤均完全闭塞, 无载瘤动脉狭窄。复合手术中, 即时造影有利于充分评估动脉瘤形态及夹闭效果, 近端临时阻断联合负压抽吸技术能够降低动脉瘤显露及塑形难度, 从而提高手术成功率、减少术后并发症。Nine patients with large complex paraclinoid aneurysms were treated by hybrid surgery in the Second Affiliated Hospital of Zhejiang University between January 2016 and July 2021.Intraoperative angiography was conducted for real-time evaluation of the aneurysm and its clipping efficacy.A total of 8 aneurysms were clipped under temporary proximal control with balloon occlusion.Suction decompression was simultaneously applied in 2 of these cases.After surgery,2 patients developed symptomatic cerebral infarction,3 patients developed transient oculomotor nerve palsy,but no patients had vision deterioration.Postoperative follow-up showed that small neck residue occurred in 1 case,but with the rest of aneurysms were completely occluded without parent artery stenosis.Hybrid surgery was proved to be advantageous in real-time assessment of aneurysm morphology and clipping efficacy.Combination of temporary proximal balloon occlusion and suction decompression technique can help in reducing the difficulty of aneurysm exposure and remodeling,thereby improving the outcome and decreasing the complications.

关 键 词：动脉瘤 复合手术 床突旁动脉瘤 近端阻断 抽吸减压 随访 

分 类 号：R651.1[医药卫生—外科学]