间接手术技术治疗颈内动脉巨大动脉瘤:一项单中心、回顾性队列研究  

Indirect surgical technique for the treatment of giant internal carotid artery aneurysms:a single-center retrospective cohort study

作　　者：丁茂华 佟小光[1] DING Maohua;TONG Xiaoguang(Department of Neurosurgery,Tianjin Huanhu Hospital,Clinical College of Neurology,Neurosurgery and Neurorehabilitation,Tianjin Medical University,Tianjin 300350,China)

机构地区：[1]天津市环湖医院(天津市脑系科中心医院)神经外科,天津医科大学神经内外科及神经康复临床学院,天津300350

出　　处：《中国神经精神疾病杂志》2024年第7期415-422,共8页Chinese Journal of Nervous and Mental Diseases

摘　　要：目的间接手术(脑血管搭桥术)治疗颈内动脉巨大动脉瘤(giant internal carotid aneurysms,GICAs)单中心经验总结。方法回顾性分析本中心2016年5月至2023年5月期间,应用间接手术技术治疗GICAs患者的临床预后。对于球囊闭塞试验阴性的GICAs患者,采用颈内动脉(internal carotid artery,ICA)缩窄术联合/不联合颞浅动脉-大脑中动脉搭桥术(superficial temporal artery-middle cerebral artery,STA-MCA)。对于球囊闭塞实验阳性的GICAs患者,采用ICA结扎术联合高流量搭桥术(external carotid artery-radial artery-middle cerebral artery/M2,ECA-RA-M2)。全脑血管造影记录患者术前术后O’Kelly-Marotta(OKM)分级,及动脉瘤最大直径变化。随访患者术前、术后改良Rankin评分(modified Rankin scale,mRS)及临床症状变化,以评估间接手术治疗GICAs的安全性与有效性。结果共有22例患者纳入本研究,接受ICA缩窄联合/不联合STA-MCA搭桥术的患者为16例,接受ICA结扎术联合高流量搭桥术的患者为6例。50%(11/22)的患者术后OKM分级达到C/D级,与术前相比,存在统计学差异(P<0.001)。术后或末次影像学随访结果显示19例患者的颅内动脉瘤缩小,2例保持不变,1例增大,较术前存在统计学差异(t=5.439,P<0.001)。至随访末,22例患者mRS评分较术前下降,且存在统计学差异(t=2.531,P=0.019)。结论在神经介入时代,间接术式仍然是治疗难治性或复发性GICAs的一种重要补充术式。Objective To summarize the single-center experience with indirect surgery(cerebrovascular bypass)for the treatment of giant internal carotid aneurysms(GICAs).Methods A retrospective analysis was conducted on the clinical outcomes of patients with GICAs treated using indirect surgical techniques at our center from May 2016 to May 2023.For patients who tested negative in the balloon occlusion test(BOT),internal carotid artery(ICA)constriction was performed with or without low-flow bypass from the superficial temporal artery(STA)to the middle cerebral artery(MCA).For patients who tested positive in the BOT,ICA ligation was combined with high-flow bypass(external carotid artery radial artery-M2).Preoperative and postoperative O’Kelly-Marotta(OKM)grading and changes in the maximum diameter of the aneurysm were examined through cerebral angiography.The preoperative and postoperative modified Rankin Scale(mRS)scores and changes in clinical symptoms were followed up to evaluate the safety and efficacy of the indirect surgery.Results A total of 22 patients were included in this study.Sixteen patients underwent ICA constriction with or without STA-MCA bypass,while six patients underwent ICA ligation combined with high-flow bypass.Postoperative OKM grades reached C/D in 50%(11/22)of the patients,showing a statistically significant improvement compared to preoperative grades(P<0.0001).Postoperative or final imaging follow-up showed that the size of aneurysms was decreased in 19 patients,remained unchanged in 2 patients,and increased in 1 patient,which reached a statistically significant difference compared to preoperative measurements(t=5.439,P<0.001).Follow-up results indicated that the mRS scores of the 22 patients decreased significantly compared to preoperative scores(t=2.531,P=0.019).Conclusion In the era of neurointervention,indirect surgical techniques remain an important complementary approach for the treatment of refractory or recurrent GICAs.

关 键 词：颈内动脉巨大动脉瘤 颈内动脉缩窄术 颈内动脉结扎术 脑血管重建术 病例回顾性研究 

分 类 号：R615[医药卫生—外科学]