开颅手术夹闭治疗破裂大脑中动脉M1段非分叉部动脉瘤的临床分析  

Clinical analysis of microsurgical clipping in the treatment of ruptured middle cerebral artery M1 segment non-bifurcation aneurysms

作　　者：张洪伟 张东 苗晓 王少敏 刘希光 孙勇 颜士卫 伏光辉[4] 李爱民 Zhang Hongwei;Zhang Dong;Miao Xiao;Wang Shaomin;Liu Xiguang;Sun Yong;Yan Shiwei;Fu Guanghui;Li Aimin(Department of Neurosurgery,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China;Department of Neurosurgery,Beijing Hospital,Beijing 100730,China;National Center of Gerontology,Beijing 100730,China;Department of Neurosurgery,Lianyungang Oriental Hospital,Lianyungang 222042,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]北京医院神经外科,北京100730 [3]国家老年医学中心,北京100730 [4]连云港市东方医院神经外科,连云港222042

出　　处：《中华神经外科杂志》2023年第12期1261-1266,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨开颅手术夹闭破裂大脑中动脉(MCA)M1段非分叉部动脉瘤的方法和治疗效果。方法回顾性分析2014年1月至2021年12月于徐州医科大学附属连云港医院神经外科接受开颅手术夹闭治疗的22例破裂MCA M1段非分叉部动脉瘤患者[占同期收治的MCA动脉瘤患者的10.6%(22/208)]的临床资料。22例患者采用经翼点入路或额外侧入路进行手术治疗。术后定期行临床随访,通过格拉斯哥预后分级(GOS)评估患者的预后,通过影像学随访评估动脉瘤有无复发。结果22例患者的动脉瘤均完成夹闭,其中动脉瘤术中破裂5例,予载瘤动脉近端临时阻断后顺利夹闭。术后12~24 h复查CT,显示脑梗死2例,脑室轻度扩张1例。术后2~3周复查CT血管成像(CTA),提示动脉瘤瘤颈少许残留1例。术后9~12个月随访,行头颅CT、CTA或数字减影血管造影检查,可见1例少许残留动脉瘤无明显变化,其余21例未见动脉瘤复发;随访期间1例出现脑积水,行脑室-腹腔分流后恢复良好。至末次随访,GOSⅤ级18例,Ⅳ级2例,Ⅲ级1例,Ⅱ级1例。结论初步研究表明,开颅手术夹闭治疗破裂MCA M1段非分叉部动脉瘤患者的预后较好,手术相关并发症较少。Objective To explore the surgical methods and therapeutic effects of microsurgical clipping of ruptured non-bifurcation aneurysms of the M1 segment of the middle cerebral artery(MCA).Methods A retrospective analysis was performed on the clinical data of 22 patients with ruptured MCA M1 segment non-bifurcation aneurysms who underwent microsurgical clipping at the Department of Neurosurgery,Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2014 to December 2021.Those cases accounted for 10.6%(22/208)of MCA aneurysms treated during the same period at the department.Twenty-two patients underwent surgical treatment through the transpterional approach or frontolateral approach.Regular clinical follow-up was performed after surgery.The patient′s outcome was evaluated by Glasgow Outcome Scale(GOS)and the recurrence of aneurysm was evaluated based on the imaging follow-up.Results The aneurysms of 22 patients were all clipped.Among them,5 cases of aneurysms ruptured during the operation and were successfully clipped after the proximal end of the parent artery was temporarily blocked.Follow-up CT scans 12 to 24 hours after surgery showed cerebral infarction in 2 cases and mild ventricular dilation in 1 case.CT angiography(CTA)was reviewed 2 to 3 weeks after surgery,which showed that there was some residual neck of aneurysm in 1 case.After 9 to 12 months of follow-up,head CT,CTA or digital subtraction angiography was performed.It was found that 1 case had a small amount of residual aneurysm without significant changes,and the remaining 21 cases had no aneurysm recurrence.During the follow-up period,1 case developed hydrocephalus and recovered well after ventriculo-peritoneal shunting.As of the last follow-up,there were 18 cases of GOS gradeⅤ,2 cases of gradeⅣ,1 case of gradeⅢ,and 1 case of gradeⅡ.Conclusion Preliminary research shows that microsurgical clipping for the treatment of ruptured MCA M1 segment non-bifurcation aneurysms is associated with a high proportion of good outcome,a low in

关 键 词：动脉瘤 破裂 大脑中动脉 M1段非分叉部动脉瘤 手术夹闭 治疗结果 并发症 

分 类 号：R651.12[医药卫生—外科学]