颅内破裂动脉瘤夹闭术中再破裂原因及处理要点分析  

Reasons and management strategies for re-rupture during clipping of ruptured intracranial aneurysms

作　　者：高永涛 陈小兵 霍峻峰 郭双磊 张鹏 Gao Yongtao;Chen Xiaobing;Huo Junfeng;Guo Shuanglei;Zhang Peng(Department of Neurosurgery,Huaihe Hospital of Henan University,Kaifeng 475000,China)

机构地区：[1]河南大学淮河医院神经外科,开封475000

出　　处：《中华神经医学杂志》2022年第11期1127-1132,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨颅内破裂动脉瘤夹闭术中不同时期再破裂的原因及处理要点。方法选择自2015年5月至2021年10月于河南大学淮河医院神经外科行显微开颅夹闭术治疗的21例颅内破裂动脉瘤患者为研究对象,患者均于术中不同时期发生再破裂。回顾性收集患者的临床特征、动脉瘤参数、预后及并发症情况等资料,并结合相关文献分别总结术中不同时期再破裂的原因及处理要点。结果21例患者的平均年龄为65岁,入院时均伴有意识障碍;Hunt-Hess分级Ⅲ级16例、Ⅳ级5例;前交通动脉瘤12例,后交通动脉瘤6例,大脑中动脉瘤3例;多子囊动脉瘤17例,不规则型动脉瘤4例;大型动脉瘤18例,巨大型动脉瘤3例。3例再破裂发生于夹闭前期(分离动脉瘤前),最终死亡2例、重残1例;14例发生于夹闭中期(分离载瘤动脉和动脉瘤时),术后发生脑梗死3例、重残3例;4例发生于夹闭后期(动脉瘤颈夹闭后),术后发生脑梗死2例、重残2例。结论患者年龄大、病情严重及动脉瘤位置、形状、体积等参数特殊以及术者经验不足、操作不当等均会导致颅内破裂动脉瘤夹闭术中发生再破裂,术中任何时期的分离夹闭均应精细轻柔,避免过度牵拉。Objective To explore the reasons and management strategies for re-rupture during clipping of ruptured intracranial aneurysms.Methods Twenty-one patients with ruptured intracranial aneurysms,accepted clipping by micro-craniotomy in Department of Neurosurgery,Huaihe Hospital of Henan University from May 2015 to October 2021,were chosen in our study.All patients suffered re-rupture at different intraoperative stages.The clinical characteristics,aneurysm parameters,prognoses and complications were retrospectively analyzed.Combined with the relevant literature,the causes and essential treatments for re-rupture at different intraoperative stages were summarized.Results The average age of these 21 patients was 65 years.All patients were accompanied by disturbance of consciousness at admission.Hunt-Hess grading III was noted in 16 patients and Hunt-Hess grading IV in 5.Anterior communicating artery aneurysms were noted in 12 patients,posterior communicating artery aneurysms in 6,and middle cerebral artery aneurysms in 3;multiple saccular aneurysms were noted in 12 patients and irregular aneurysms in 4;large aneurysms were noted in 18 patients and giant aneurysms in 3.Among the 3 patients with re-rupture at the early stage of clipping(before aneurysm separation),2 were died and 1 was severely disabled;among the 14 patients with re-rupture at the middle stage of clipping(during separation of aneurysm from its parent artery),3 had cerebral infarction and 3 had severe disability after surgery;among the 4 patients with re-rupture at the late stage of clipping(after clipping of the aneurysm neck),2 had cerebral infarction and 2 had severe disability.Conclusion Patients would trend to have re-rupture during clipping of ruptured intracranial aneurysms in cases that patients have older age,severe diseases and special parameters(locations,shapes,volumes)of the aneurysms,surgeries are operated by inexperienced operator,or surgeries have improper intraoperative operations;during any period of the surgery,the separation and clamping

关 键 词：颅内动脉瘤 破裂动脉瘤 再破裂 开颅夹闭术 

分 类 号：R651.11[医药卫生—外科学]