CAJ | 학술논문

目的探讨硬性内镜在颅内动脉瘤手术中的应用,分析其优缺点.方法回顾性分析63例患者66个动脉瘤的显微手术,其中63个破裂动脉瘤,3个未破裂动脉瘤.多数患者在内镜辅助下完成动脉瘤夹闭术,包括动脉瘤夹闭前后对载瘤动脉、瘤颈及瘤周穿通支的观察,以确定最佳夹闭位置和程度.结果内镜能更好地观察瘤周局部解剖结构,保证首次最佳夹闭,5例第一次夹闭后,经内镜发现夹闭不佳而重新调整动脉瘤夹,其中1例颈内后交通动脉瘤夹闭不全;1例颈内动脉眼动脉瘤夹闭不全;1例颈内后交通动脉瘤夹闭动脉瘤同时夹闭后交通动脉;2例前交通动脉瘤夹闭穿通支.在使用内镜过程中造成1例轻度颞叶脑挫伤,在所有过程中未造成动脉瘤破裂出血.结论在颅内动脉瘤夹闭过程中辅助使用内镜,能更好地观察动脉瘤及其周围的局部解剖结构,提高动脉瘤夹闭手术的质量.
목적 탐토경성내경재로내동맥류수술중적응용,분석기우결점.방법 회고성분석63례환자66개동맥류적현미수술,기중63개파렬동맥류,3개미파렬동맥류.다수환자재내경보조하완성동맥류협폐술,포괄동맥류협폐전후대재류동맥、류경급류주천통지적관찰,이학정최가협폐위치화정도.결과 내경능경호지관찰류주국부해부결구,보증수차최가협폐,5례제일차협폐후,경내경발현협폐불가이중신조정동맥류협,기중1례경내후교통동맥류협폐불전;1례경내동맥안동맥류협폐불전;1례경내후교통동맥류협폐동맥류동시협폐후교통동맥;2례전교통동맥류협폐천통지.재사용내경과정중조성1례경도섭협뇌좌상,재소유과정중미조성동맥류파렬출혈.결론 재로내동맥류협폐과정중보조사용내경,능경호지관찰동맥류급기주위적국부해부결구,제고동맥류협폐수술적질량.
Objective To evaluate the usefulness of endoscope in the microsurgical treatment of intraeranial aneurysms and analyze its benefits.risksand disadvantages.Mehtods We retrospectively study 63 patients with 66 aneurysms,treated between Janurary 2007 and October 2007,for whom the endoscope were used to assist the mierosurgical treatment of lesions.63 aneurysms were ruptured.In most of the cases,the endoscope was used in addition to microsurgical dissection and clipping(before,during and after clipping).Observation of the anatomic features of necks,perforators and selection of optimal clip position were performed.Results In the majority of cases,the endoscope was used.The clip Was repositioned in five aneurysm operations.including incomplete neck obliteration in 1 case of intracarotidophathalmic aneurysm,incomplete neck obliteration in 1 ICA-PCoA aneurysms,involvement of perforating vessels with the clip in 1 ICA-PCoA aneurysms,involvement of perforating vessels with the clip in 2 ACoA aneurysms.One patient experienced a mild temporal lobe contusion during the application of endoscope.There Was no intra-operative aneurysm rapture due to endoscope manipulation.Conclusioas Endoscope is vary useful during cerebral aneurysm surgery.It can provide valuable information for the assessment of regional anatomic features around aneurysm and improve the quality of aneurysm surgery.