颅内动脉瘤夹闭术后残留和复发的处理  

Management of residual and recurrent intracranial aneurysms after clipping

作　　者：谭道德[1] 彭远林[1] 张雨涛[1] 阮庆 万虎 李昂 李进[2] TAN Daode;PENG Yuanlin;ZHANG Yutao;RUAN Qing;WAN Hu;LI Ang;LI Jin(Department of Neurosurgery,Leshan Geriatric Hospital,Leshan 614000,China)

机构地区：[1]乐山市老年病专科医院神经外科,乐山614000 [2]四川大学华西医院神经外科

出　　处：《临床神经外科杂志》2025年第2期126-130,共5页Journal of Clinical Neurosurgery

基　　金：四川省区域创新合作项目(2023YFQ0038)。

摘　　要：目的 探讨颅内动脉瘤夹闭术后残留和复发的特点以及再次治疗的技术难点及疗效。方法 回顾性分析四川大学华西医院神经外科2014年1月—2024年1月收治的15例颅内动脉瘤夹闭术后残留和复发患者的临床资料,并结合相关文献进行复习。结果 第一次术后随访发现动脉瘤完全夹闭7例,动脉瘤残留8例。从动脉瘤初次夹闭到复发最短1个月,最长20年,平均50.5个月。动脉瘤再治疗原因包括完全夹闭后动脉瘤复发增大及残留动脉瘤进行性增大。10例复发动脉瘤行开颅夹闭术,其中2例术后发生脑梗死;介入栓塞5例,均恢复较好。结论 对于残留的动脉瘤,其增大及破裂的风险较高,因此应进行严密的定期随访。对于夹闭术后复发的动脉瘤,介入栓塞是一种安全有效的治疗方法。对于不适合介入栓塞的病例,外科治疗就需要克服再次手术的技术困难及掌握各种血管手术的技巧。Objective To explore the characteristics of residual and recurrent intracranial aneurysms after clipping,as well as the difficulties and efficacy of re-treatment.Methods A total of 15 patients with intracranial residual and recurrent aneurysms after clipping admitted to Department of Neurosurgery,Leshan Geriatric Hospital from January 2014 to January 2024 were retrospectively analyzed and the relevant literature were reviewed.Results At the first postoperative follow-up,7 cases were found to be completely clipped and 8 cases showed small remnants.The shortest time from aneurysm clipping to recurrence was 1 month,and the longest was 20 years with an average of 50.5 months.The reasons for the retreatment of aneurysms included the recurrence and enlargement of aneurysms after complete clipping,as well as the progressive enlargement of residual aneurysms.Re-clipping was performed in 10 cases of recurrent aneurysms,2 of them suffered postoperative cerebral infarction.The remaining 5 patients with endovascular embolization recovered well.Conclusions The residual aneurysms have a higher risk of regrowth and rupture.As a result,they should be followed closely and regularly.Interventional embolization is a safe and effective treatment for recurrent aneurysms after clipping.For cases unsuitable for interventional embolization,surgical treatment needs to overcome the technical difficulties of reoperation and master various skills of vascular surgery.

关 键 词：颅内动脉瘤 手术技巧 复发动脉瘤 残留动脉瘤 

分 类 号：R743[医药卫生—神经病学与精神病学]