复杂颅内动脉瘤颅内-颅内血管搭桥术  

The application of intracranial-intracranial bypass for the treatment of complex intracranial aneurysms

作　　者：苏赢 刘佩玺 史源 李培良 安庆祝 田彦龙 朱巍 SU Ying;LIU Pei-xi;SHI Yuan;LI Pei-liang;AN Qing-zhu;TIAN Yan-long;ZHU Wei(Department of Neurosurgery,Linyi Central Hospital,Linyi 276400,Shandong,China;Department of Neurosurgery,National Center for Neurological Disorders,Shanghai Key Laboratory of Brain Function and Restoration and Neural Regeneration,Neurosurgical Institute of Fudan University,Shanghai Clinical Medical Center of Neurosurgery,Huashan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]山东省临沂市中心医院神经外科,276400 [2]复旦大学附属华山医院神经外科、国家神经疾病医学中心、上海市脑功能重塑及神经再生重点实验室、复旦大学神经外科研究所、上海市神经外科临床医学中心,200032

出　　处：《中国现代神经疾病杂志》2024年第8期644-650,共7页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：上海市优秀学术带头人计划项目(项目编号:21XD1400600);上海市“医苑新星”青年医学人才培养资助计划项目(项目编号:30302106001)。

摘　　要：目的 探讨颅内-颅内血管搭桥术治疗复杂颅内动脉瘤的疗效及安全性。方法与结果 纳入2015年1月至2023年12月在复旦大学附属华山医院行颅内-颅内血管搭桥术的32例复杂颅内动脉瘤患者,手术方式为脑血管原位重建、再移植、再吻合及短距桥接,其中大脑中动脉动脉瘤(16例)原位重建5例,再移植1例,再吻合3例,短距桥接7例;大脑前动脉动脉瘤(8例)原位重建5例,再移植3例;前交通动脉动脉瘤(2例)均为原位重建;后循环动脉瘤(6例)原位重建3例,再吻合2例,短距桥接1例。术中桥血管通畅率达100%,无桥血管闭塞患者。参与术后6个月以上影像学随访的23例患者影像学均未见明显复发;参与改良Rankin量表随访的28例患者中5分1例,3分5例,2分2例,1分1例,0分19例。术后出现出血性并发症3例(9.37%),缺血性并发症10例(31.25%),无患者接受非计划二次手术治疗并发症。结论 颅内-颅内血管搭桥术治疗复杂颅内动脉瘤疗效及安全性较好,在复杂颅内动脉瘤的显微外科治疗中具有独特优势。Objective To explore the efficacy and safety of intracranial-intracranial bypass for the treatment of complex intracranial aneurysms.Methods and Results A total of 32 patients with complex intracranial aneurysms who were hospitalized for treatment at Huashan Hospital,Fudan University from January 2015 to December 2023 were included.Surgical methods included in-situ bypass,reimplantation,reanastomosis and bypass with interposition graft.For middle cerebral artery(MCA)aneurysms(n=16),there were 5 cases of in-situ bypass,one case of reimplantation,3 cases of reanastomosis,and 7 cases of bypass with interposition graft.For anterior cerebral artery(ACA)aneurysms(n=8),there were 5 cases of in-situ bypass and 3 cases of reimplantation.For anterior communicating artery(ACoA)aneurysms(n=2),both cases were in-situ bypass.For posterior circulation aneurysms(n=6),there were 3 cases of in-situ bypass,2 cases of reanastomosis,and one case of bypass with interposition graft.The intraoperative graft vessels patency rate was 100%.Among the 23 patients who participated in follow-up imaging for more than 6 months postoperatively,no obvious recurrence was indicated by imaging.Among the 28 patients who participated in modified Rankin Scale(mRS)follow-up,there was one case of 5,5 cases of 3,2 cases of 2,one case of 1,and 19 cases of 0.Postoperative hemorrhagic complications occurred in 3 cases(9.37%),and ischemic complications occurred in 10 cases(31.25%),with no patients requiring unplanned secondary surgery for complication treatment.Conclusions Intracranial-intracranial bypass has good efficacy and safety for the treatment of complex intracranial aneurysms and has unique advantages in the microsurgical treatment of complex intracranial aneurysms.

关 键 词：颅内动脉瘤 脑血管重建术 血流动力学 

分 类 号：R651.12[医药卫生—外科学]