CAJ | 학술논문

目的探讨颅内动脉瘤破裂超早期手术治疗的可行性和治疗效果.方法 13例不同部位颅内动脉瘤患者,经三维CT造影(30-CTA)检查证实后即在24h内全麻下行开颅动脉瘤夹闭术,其中6h内手术5例、6-24h手术8例.术前Hunt-Hess分级:Ⅳ级10例,V级3例.术后根据出院时COS结果评价治疗效果.结果术中发生动脉瘤破裂并临时阻断4例,分离困难6例;术后出现脑积水并行脑室腹腔分流术3例,肺部感染3例,下丘脑反应伴上消化道出血2例,额叶梗死1例;出院时效果良好6例;预后差5例;死亡2例.结论对Hunt-Hess分级Ⅳ～V级的患者实施超早期手术治疗可避免动脉瘤早期再次破裂出血;3D-CTA的应用使超早期手术成为可能.改善治疗效果.
목적 탐토로내동맥류파렬초조기수술치료적가행성화치료효과.방법 13례불동부위로내동맥류환자,경삼유CT조영(30-CTA)검사증실후즉재24h내전마하행개로동맥류협폐술,기중6h내수술5례、6-24h수술8례.술전Hunt-Hess분급:Ⅳ급10례,V급3례.술후근거출원시COS결과평개치료효과.결과 술중발생동맥류파렬병림시조단4례,분리곤난6례;술후출현뇌적수병행뇌실복강분류술3례,폐부감염3례,하구뇌반응반상소화도출혈2례,액협경사1례;출원시효과량호6례;예후차5례;사망2례.결론 대Hunt-Hess분급Ⅳ～V급적환자실시초조기수술치료가피면동맥류조기재차파렬출혈;3D-CTA적응용사초조기수술성위가능.개선치료효과.
Objective To discuss the possibility and therapeutic effect of ultra-early surgery for grade IV～V intraeranial aneurysms scored by Hunt-Hess grading system.Methods Thirteen cases suffered from intracranial aneurysms determined by 3D-CTA were treated by ultra-early surgery under general anesthesia within 24 hours(5 casses were treated within 6 hours and 8 Cases in 6-24 hours).Preoperative Hunt-Hess grade:10 cases were grade IV and 3 cases were grade V.The therapeutic effects were evaluated by Glasgow Outcome Score(COS).Results In operation,difficult dissection occurred in 6 cases,rupture of aneurysm occurred and temporary obstructions were performed in 4 Cases.After the clipping of aneurysms,there wei-e 3 cases underwent V-P shunt because of hydrocephalus,3 cases of pulmonary infection,2 cases of hypothalamus reaelion accompanied with hemorrhage in upper digestive tract and 1 case of frontal infarction.The therapeutic effects were good in 6 cases,worse in 5 cases,dead in 2 cases.Conclusions IThe ultra-early surgery could avoid early re-bleeding of intraeranial aneurysm and is suitable for intracranial aneurysrm of Hunl-Hess grade IV-V.The application of 3D-CTA could make it possible for using ultra-early surgery,and improve the therapeutic effect.