基层医院显微外科手术治疗颅内破裂动脉瘤13例临床分析  

Clinical Analysis of Microsurgical Treatment of 13 Cases with Ruptured Intracranial Aneurysm in Primary Level Hospital

作　　者：刘忠杰 景登荣 田华 刘建刚[2] Liu Zhongjie;Jing Dengrong;Tian Hua;Liu Jiangang(Tongren Shiqian County People's Hospital,Tongren 555100,Guizhou Province,China;The First Affiliated Hospital of Soochow University,Suzhou 215000,Jiangsu Province,China)

机构地区：[1]铜仁市石阡县人民医院,贵州铜仁555100 [2]苏州大学附属第一医院,江苏苏州215000

出　　处：《中外医药研究》2023年第34期21-23,共3页JOURNAL OF CHINESE AND FOREIGN MEDICINE AND PHARMACY RESEARCH

基　　金：贵州省卫生健康委员会科学技术基金(编号:gzwjk2021-190);江苏省研究生科研与实践创新计划项目(编号:KYCX20_2697)。

摘　　要：总结基层医院开展急诊显微外科手术治疗颅内破裂动脉瘤的经验及体会。回顾性分析2017年8月—2021年1月于铜仁市石阡县人民医院行颅内动脉瘤显微外科手术治疗的患者13例临床数据。13例患者共有动脉瘤13个,大脑中动脉动脉瘤5例,前交通动脉瘤3例,颈内动脉后交通段动脉瘤4例,颈内动脉床突旁动脉瘤1例。所有患者经翼点开颅动脉瘤夹闭术治疗,术中发生动脉瘤破裂3例,所有动脉瘤术中顺利夹闭。行去骨瓣减压6例,骨瓣复位7例。术后CT提示无再出血发生,术后并发脑血管痉挛6例、脑积水2例、癫痫发作3例。术后随访3个月,根据格拉斯哥预后评分分为预后不良5例,恢复良好8例。2例患者死亡。基层医院在配备有高排CT机、显微镜及相关显微手术器械的情况下,医师通过颅脑局部解剖学习及显微外科技术训练,严格掌握并筛选动脉瘤破裂手术指征,可以行颅内动脉瘤显微外科手术治疗。The experience and understanding of microsurgical treatment of ruptured intracranial aneurysm in primary level hospital are summarized.Clinical date of 13 patients who received microsurgical treatment of ruptured intracranial aneurysm in Shiqian County People's Hospital from August 2017 to January 2021 were retrospectively analyzed.The 13 patients had 13 aneurysms in total,including 5 cases with middle cerebral aneurysms,3 cases with anterior communicating aneurysms,4 cases with posterior communicating aneurysms of internal carotid artery,and 1 case with paraclinoid aneurysm of internal carotid artery.All patients were treated by craniotomy and aneurysm clipping through pterion approach,3 cases developed aneurysm rupture during the operation and all aneurysms were smoothly clipped during the operation.Decompressive craniectomy were performed in 6 patients and bone flap reduction was performed in 7 patients.After surgery,no hemorrhage occurred according to CT scan,6 cases developed cerebral vasospasm,2 cases developed hydrocephalus and 3 cases developed epileptic seizure.After 3 months of follow-up,5 patients had poor prognosis and 8 patients had good recovery according to Glasgow Outcome Score.Two patients died.In primary level hospital equipped with high row CT machine,microscope,microsurgical instrument and so on,the doctors who strictly grasp and screen the indications for aneurysm rupture through local cranial anatomy learning and microsurgical technology training are eligible for performing microsurgical treatment of ruptured intracranial aneurysm.

关 键 词：动脉瘤破裂 基层医院 显微治疗 预后 

分 类 号：R65[医药卫生—外科学]