CAJ | 학술논문

目的　对1985年以来经手术治疗的18例前循环巨大动脉瘤作一回顾性分析。方法　行动脉瘤瘤颈夹闭术11例，动脉瘤孤立或孤立后切除4例，动脉瘤切除或孤立后载瘤动脉重建2例，动脉瘤包裹1例。结果　动脉瘤瘤颈夹闭术的11例病人中，除1例术前Hunt-Hess分级IV级的病人术后重残外，均恢复良好。动脉瘤孤立或孤立后切除的4例病人中，1例后交通动脉瘤(PCoA)病人虽术前血管造影证实侧支循环充分，但术后出现暂时性对侧轻偏瘫。另1例大脑中动脉(MCA)动脉瘤病人术后第6天因术野血肿再次进行手术，出院时能独立行走。行动脉瘤切除或孤立后载瘤动脉重建的2例病人恢复良好。动脉瘤包裹术的1例病人术后因再出血死亡。结论　为消除巨大动脉瘤的压迫症状和潜在的出血危险，对前循环巨大动脉瘤主张积极的手术治疗。动脉瘤瘤颈夹闭并保留载瘤动脉通畅是首选治疗，对必需行动脉瘤孤立且交叉循环不良的病例，应尽可能重建载瘤动脉。
목적　대1985년이래경수술치료적18례전순배거대동맥류작일회고성분석。방법　행동맥류류경협폐술11례，동맥류고립혹고립후절제4례，동맥류절제혹고립후재류동맥중건2례，동맥류포과1례。결과　동맥류류경협폐술적11례병인중，제1례술전Hunt-Hess분급IV급적병인술후중잔외，균회복량호。동맥류고립혹고립후절제적4례병인중，1례후교통동맥류(PCoA)병인수술전혈관조영증실측지순배충분，단술후출현잠시성대측경편탄。령1례대뇌중동맥(MCA)동맥류병인술후제6천인술야혈종재차진행수술，출원시능독립행주。행동맥류절제혹고립후재류동맥중건적2례병인회복량호。동맥류포과술적1례병인술후인재출혈사망。결론　위소제거대동맥류적압박증상화잠재적출혈위험，대전순배거대동맥류주장적겁적수술치료。동맥류류경협폐병보류재류동맥통창시수선치료，대필수행동맥류고립차교차순배불량적병례，응진가능중건재류동맥。
Objective　To analyze the results of our 18 patients with the giant aneurysms of the anterior circulation retrospectively. Methods　All patients had been surgically treated, of which, direct clipping of the aneurysms was accomplished in 11 patients, aneurysms trapping or removal after trapping in 4, aneurysms excision or trapping with parent artery anastomosis in 2, and aneurysms wrapping in 1. Results　Early postoperative neurological function was evaluated according to Glasgow Outcome Scale. All 11 patients with direct clipping of the aneurysms and 2 patients performed aneurysms excision or trapping with parent artery anastomosis gained good recovery except for one who had preoperative IV grade according to Hunt and Hess grades after SAH and underwent severe disability postoperatively. In 4 patients with aneurysms trapping or excision after trapping, 1 patient experienced temporary contralateral hemiparesis, and another patient in this group underwent the hemorrhage in the operative field and recovered smoothly after a second operation for eliminating hematoma. 1 patient with aneurysmre wrapping died due to postoperative aneurysm rebleeding. Conclusions　Direct clipping of the aneurysms is the preferred method for the giant intracranial aneurysms, Unclippable aneurysms require alternative methods that might compromise parent arteries and may require revascularization to restore sufficient cerebral blood flow.