额外侧锁孔入路低分级颈内动脉交通段动脉瘤夹闭术中分支动脉的保护  

Protection of branches during clipping of low grade internal carotid communicating segment aneurysms via frontolateral keyhole approach

作　　者：张洪伟 张东[2] 顾艳 李爱民 Zhang Hongwei;Zhang Dong;Gu Yan;Li Aimin(Department of Neurosurgery,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China;Department of Neurosurgery,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China;Department of Radiology,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China)

机构地区：[1]徐州医科大学附属连云港医院神经外科,连云港222002 [2]首都医科大学附属北京天坛医院神经外科,北京100070 [3]徐州医科大学附属连云港医院影像科,连云港222002

出　　处：《中华神经医学杂志》2022年第8期795-800,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨经额外侧锁孔入路行低分级颈内动脉交通段(C7段)动脉瘤夹闭手术时对分支动脉保护的临床经验及效果。方法选择徐州医科大学附属连云港医院神经外科自2017年1月至2020年12月行经额外侧锁孔入路动脉瘤夹闭手术治疗的52例Hunt-Hess分级Ⅰ~Ⅲ级颈内动脉C7段动脉瘤患者进行研究,其中后交通动脉瘤45例、脉络膜前动脉瘤6例、后交通动脉瘤合并脉络膜前动脉瘤1例。术中仔细明确分支动脉起始部与瘤颈的关系,并在颈内动脉第Ⅱ、Ⅲ及Ⅴ间隙探查分支动脉走形及其与瘤体的关系,必要时辅助以吲哚菁绿荧光造影;选择适合动脉瘤夹或行动脉瘤夹组合夹闭动脉瘤;夹闭完成后行镜下或内镜探查、吲哚菁绿荧光造影,对分支动脉误夹或狭窄者予以重新夹闭。结果术中有6例患者的分支动脉误夹(后交通动脉4例、脉络膜前动脉1例、颈内动脉分叉部穿支动脉1例),予以调整或更换动脉瘤夹后重新夹闭。52例患者的动脉瘤均成功夹闭。术后24 h内头颅CT复查示分支动脉供血区局灶性脑梗死5例,其中3例伴对侧肢体肌力下降(分别为4级、3级和1级),予药物及神经康复治疗;余47例一般情况好、无特殊。术后随访9~12个月,3例对侧肢体肌力下降患者的肌力分别恢复至5级、4级和2级;所有患者的动脉瘤均无残留或复发,末次随访时格拉斯哥预后评分5分47例、4分3例、3分1例、2分1例。结论在经额外侧锁孔入路动脉瘤夹闭手术治疗低分级颈内动脉C7段动脉瘤术中,采用多种保护方式积极防止分支动脉的损伤,可有效降低术后脑梗死的发生,改善患者预后。Objective To investigate the clinical experiences and outcomes of protection of branches during clipping of low grade internal carotid communicating segment(C7)aneurysms via frontolateral keyhole approach.Methods Fifty-two patients with internal carotid C7 aneurysms and Hunt-Hess grading I-III,admitted to our hospital from January 2017 to December 2020,were chosen;45 patients were with posterior communicating artery(PCoA)aneurysms,6 patients were with anterior choroidal artery(ACHA)aneurysms,and one patient was with PCoA aneurysm combined with ACHA aneurysm.The relation between origin of the branch arteries and tumor neck was determined during surgery.The relation between shape of the branch arteries and tumor body was investigated in the Spaces II,III and V of the internal carotid artery(indocyanine green fluorescence angiography was used when necessary);the aneurysms were clipped by appropriate aneurysm clip or clips combination;after clipping,microspic or endoscopic exploration and indocyanine green fluorescence angiography were performed,and re-clipping was performed in the misclipped or stenosed branch arteries.Results During the surgery,the branch arteries of 6 patients(4 from posterior communicating artery,1 from anterior choroidal artery,and 1 from perforator artery at the bifurcation of internal carotid artery)were misclipped,and therefore,the aneurysm clips were adjusted or replaced and then re-clipped.Aneurysms were successfully clipped in all 52 patients.Brain CT examination within 24 h of surgery showed that focal cerebral infarction in the branch artery feeding area was noted in 5 patients,of which 3 patients were accompanied by contralateral limb muscle strength decline(grading 4,grading 3 and grading 1,respectively)and medication and neurological rehabilitation were given.The other 47 patients had good general condition without special condition.During the follow-up of 9-12 months,the muscle strength of 3 patients with decreased contralateral limb strength recovered to grading 5,4 and 2,respective

关 键 词：经额外侧锁孔入路 颈内动脉交通段 分支动脉 后交通动脉瘤 脉络膜前动脉瘤 夹闭手术 

分 类 号：R651.12[医药卫生—外科学]