中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2012年
6期
548-551
,共4页
许斌%史怀璋%徐善才%季智勇%吴培%初明
許斌%史懷璋%徐善纔%季智勇%吳培%初明
허빈%사부장%서선재%계지용%오배%초명
大脑中动脉%基底动脉%支架%脑出血
大腦中動脈%基底動脈%支架%腦齣血
대뇌중동맥%기저동맥%지가%뇌출혈
Middle cerebral artery%Basilar artery%Stents%Cerebral hemorrhage
目的 探讨支架成形术治疗颅内动脉狭窄导致出血并发症的常见原因及防治措施.方法 回顾性分析2006年7月至2011年12月完成的366例颅内支架成形术的临床资料.有14例发生出血并发症,其中男12例、女2例,年龄36 ~76岁,平均(57±12)岁.以接受手术的前100例为界限分为前期手术组和后期手术组.分析导致出血的原因,探讨如何预防及处理出血并发症.结果 本组颅内支架成形术出血并发症总发生率3.8% (14/366),前期手术组发生率10.0% (10/100)、后期手术组发生率1.5% (4/266).其中6例出血并发症与手术操作相关,1例是微导丝置于远端分支动脉时刺破动脉、1例球囊扩张时导致血管破裂、1例将球囊于支架内再次扩张后发生出血、3例微导丝头端突然前蹿刺破了分支动脉;8例与过度灌注相关,其中3例为适应证掌握不严格所致;死亡6例,重残3例,轻瘫痪2例,3例无神经功能缺失.结论 颅内支架成形术出血并发症具有较高的致残率和致死率,但术者可以在提高手术操作技巧、严格选择适应证的基础上,减少出血并发症的发生.
目的 探討支架成形術治療顱內動脈狹窄導緻齣血併髮癥的常見原因及防治措施.方法 迴顧性分析2006年7月至2011年12月完成的366例顱內支架成形術的臨床資料.有14例髮生齣血併髮癥,其中男12例、女2例,年齡36 ~76歲,平均(57±12)歲.以接受手術的前100例為界限分為前期手術組和後期手術組.分析導緻齣血的原因,探討如何預防及處理齣血併髮癥.結果 本組顱內支架成形術齣血併髮癥總髮生率3.8% (14/366),前期手術組髮生率10.0% (10/100)、後期手術組髮生率1.5% (4/266).其中6例齣血併髮癥與手術操作相關,1例是微導絲置于遠耑分支動脈時刺破動脈、1例毬囊擴張時導緻血管破裂、1例將毬囊于支架內再次擴張後髮生齣血、3例微導絲頭耑突然前躥刺破瞭分支動脈;8例與過度灌註相關,其中3例為適應證掌握不嚴格所緻;死亡6例,重殘3例,輕癱瘓2例,3例無神經功能缺失.結論 顱內支架成形術齣血併髮癥具有較高的緻殘率和緻死率,但術者可以在提高手術操作技巧、嚴格選擇適應證的基礎上,減少齣血併髮癥的髮生.
목적 탐토지가성형술치료로내동맥협착도치출혈병발증적상견원인급방치조시.방법 회고성분석2006년7월지2011년12월완성적366례로내지가성형술적림상자료.유14례발생출혈병발증,기중남12례、녀2례,년령36 ~76세,평균(57±12)세.이접수수술적전100례위계한분위전기수술조화후기수술조.분석도치출혈적원인,탐토여하예방급처리출혈병발증.결과 본조로내지가성형술출혈병발증총발생솔3.8% (14/366),전기수술조발생솔10.0% (10/100)、후기수술조발생솔1.5% (4/266).기중6례출혈병발증여수술조작상관,1례시미도사치우원단분지동맥시자파동맥、1례구낭확장시도치혈관파렬、1례장구낭우지가내재차확장후발생출혈、3례미도사두단돌연전찬자파료분지동맥;8례여과도관주상관,기중3례위괄응증장악불엄격소치;사망6례,중잔3례,경탄탄2례,3례무신경공능결실.결론 로내지가성형술출혈병발증구유교고적치잔솔화치사솔,단술자가이재제고수술조작기교、엄격선택괄응증적기출상,감소출혈병발증적발생.
Objective To summarize the reasons of bleeding complications and the prevention methods in stenting for intracranial arterial stenosis.Methods The clinical data of 366 patients underwent stent-assistant angioplasty of intracranial artery stenosis from July 2006 to December 2011were analyzed retrospectively.Among them,14 patients with bleeding complications were found.The initial 100 patients were categorized as early stage group and the rest as mature stage group.The reasons of bleeding and the methods for preventing this complication were summarized.Results The overall incidence of bleeding complication was 3.8% (14/366).In the early stage group and mature stage group,the rates was 10%(10/100) and 1.5% (4/266).Six cases were related to the operational manipulation and 8 cases secondary to hyperperfusion injury.Death was found in 6 patients,severe disability in 3,mild paralysis in 2,and no neurological deficits in 3.Conclusions The bleeding complications in stent-assisted angioplasty of intracranial artery stenosis have a high disability and mortality.The improvement of operative techniques and the more strict indications decrease the bleeding complications rate effectively.