CAJ | 학술논문

经翼点入路前交通动脉瘤的显微手术治疗(附398例报告)
경익점입로전교통동맥류적현미수술치료(부398례보고)
Microsurgical clipping by pterional approach for an anterior communicating artery aneurysm

万方数据

中华神经外科杂志中華神經外科雜誌 중화신경외과잡지
Chinese Journal of Neurosurgery
2009年 7期 630-632 ,共3页

高宝山%孙丕通%张健%许友松%徐英辉%段云平%邓东风%常庆勇%刘荣耀%廉志刚%卢军%白景阳

고보산%손비통%장건%허우송%서영휘%단운평%산동풍%상경용%류영요%렴지강%로군%백경양

颅内动脉瘤%脑血管造影术%翼点入路%前交通动脉顱內動脈瘤%腦血管造影術%翼點入路%前交通動脈
로내동맥류%뇌혈관조영술%익점입로%전교통동맥
Intracranial aneurysm%Cerebral angiography%Pterional approach%Anterior communicating artery

目的总结经翼点入路显微手术夹闭前交通动脉痛的优缺点.方法对398例前交通动脉瘤采用经翼点入路直接夹闭术的结果进行回顾性分析.由于舣侧A1段常发育异常及相应的前交通动脉的血流方向的个体差异,动脉瘤的形态变化及生长方向不同,手术入路的定侧与难度亦有所不同.结果本组病例中6例(Hunt-HessⅣ级2例, Ⅴ级4例)由于严重脑血管痉挛等并发症,分别于术后3 d至3周内死亡.随诊时间为3个月至22年不等,短期内全组病人均获得随诊,但长期随诊者为295例,97例失访.随访的病人中Ⅰ、Ⅱ级214例(72%)均恢复正常工作,Ⅲ级者42例(14%)恢复正常工作,23例(7.7%)生活自理,3例(1%)不能生活自理.Ⅳ级者中有4例(1.3%)恢复正常工作;Ⅴ级中有1例恢复正常工作,1例不能生活自理.结论经翼点人路直接显微手术,是治疗前交通动脉瘤较为理想的方法.手术前仔细阅片,了解前交通动脉区的血管关系及血流变化,对于手术入路选择至关重要.
목적 총결경익점입로현미수술협폐전교통동맥통적우결점.방법 대398례전교통동맥류채용경익점입로직접협폐술적결과 진행회고성분석.유우의측A1단상발육이상급상응적전교통동맥적혈류방향적개체차이,동맥류적형태변화급생장방향불동,수술입로적정측여난도역유소불동.결과 본조병례중6례(Hunt-HessⅣ급2례, Ⅴ급4례)유우엄중뇌혈관경련등병발증,분별우술후3 d지3주내사망.수진시간위3개월지22년불등,단기내전조병인균획득수진,단장기수진자위295례,97례실방.수방적병인중Ⅰ、Ⅱ급214례(72%)균회복정상공작,Ⅲ급자42례(14%)회복정상공작,23례(7.7%)생활자리,3례(1%)불능생활자리.Ⅳ급자중유4례(1.3%)회복정상공작;Ⅴ급중유1례회복정상공작,1례불능생활자리.결론 경익점인로직접현미수술,시치료전교통동맥류교위이상적방법.수술전자세열편,료해전교통동맥구적혈관관계급혈류변화,대우수술입로선택지관중요.
Objective To analyse, the advantages of the pterional approach to an anterior communicating artery aneurysm. Method 398 cases of an anterior communicating aneurysm were clipping treated by the pterional approach, The site of an aneurysmal neck and the direction of growing projection mustbe classified accurately from the preoperative angiography. Results 6 of eases died of serious vasospasm; During 3months-22years,295 cases were followed up,all of cases with Hunt-hess 1 and 2 were good(72%), 42 of cases with 3 recovered(14%) ,4 of cases with 4 returned to normal(1.3%) ,one case recovered and one disabled in the group with 5. Conclusions Although a pterionai approach to an anterior communicating artery anrurysm is an excellent accessing method,it should be emphasized the preoperative evaluation the aneurysmal neck, position, direction, relation of vaseulars around anterior communicating artery aneurysm and anomalies.