CAJ | 학술논문

目的探讨床突旁大型或巨大动脉瘤手术中血液回抽吸技术的方法和效果.方法 12例颈内动脉床突旁段大型或巨大动脉瘤均采用翼点入路,颈内动脉临时阻断孤立动脉瘤后用18号套管针在颈部颈内动脉阻断的远端穿刺,将套管针尾部用负压吸引器连接到血液回收装置,在不切开动脉瘤的情况下使动脉瘤塌陷.术中应用脑电图和体感诱发电位监测.结果 8例血液逆向抽吸后动脉瘤明显塌陷,将动脉瘤壁与周围结构剥离后夹闭.4例逆向抽吸后动脉瘤塌陷不明显,其中3例切开动脉瘤去除瘤内血栓后夹闭动脉瘤,1例改做动脉瘤孤立并行大隐静脉移植颈外动脉-大脑中动脉搭桥.8例术后行DSA检查,动脉瘤均夹闭满意.按改良COS评分术后良好为10例,差为1例,死亡l例.结论血液回抽吸方法能使大部分床突旁大型或巨大动脉瘤塌陷,从而获得安全和满意的夹闭.术中应用电生理监测有助于发现早期的脑缺血和判断动脉瘤夹闭后有无载瘤动脉狭窄或误夹.
목적 탐토상돌방대형혹거대동맥류수술중혈액회추흡기술적방법화효과.방법 12례경내동맥상돌방단대형혹거대동맥류균채용익점입로,경내동맥림시조단고립동맥류후용18호투관침재경부경내동맥조단적원단천자,장투관침미부용부압흡인기련접도혈액회수장치,재불절개동맥류적정황하사동맥류탑함.술중응용뇌전도화체감유발전위감측.결과 8례혈액역향추흡후동맥류명현탑함,장동맥류벽여주위결구박리후협폐.4례역향추흡후동맥류탑함불명현,기중3례절개동맥류거제류내혈전후협폐동맥류,1례개주동맥류고립병행대은정맥이식경외동맥-대뇌중동맥탑교.8례술후행DSA검사,동맥류균협폐만의.안개량COS평분술후량호위10례,차위1례,사망l례.결론 혈액회추흡방법능사대부분상돌방대형혹거대동맥류탑함,종이획득안전화만의적협폐.술중응용전생리감측유조우발현조기적뇌결혈화판단동맥류협폐후유무재류동맥협착혹오협.
Objective To explore the technique and effect of retrograde suction decompression for the management of large or giant paraclinoidal aneurysms. Method 12 cases of paraclinoidal aneurys msused pterional approach. After temporary trapping, a No. 18 angiocatheter is inserted into the cervical internal carotid artery. This catheter is then connected to a blood reuse unit, which is connected to a wall suction, allowing the aneurysm rapid deflation without the cutting of aneurysm, lntraoperative EEG and SEP monitoring was applied to check the brain function. Results The aneurysms significantly deflated after the retrograde suction and were clipped safely and satisfactorily in 8 cases. The aneurysms didn't deflate in 4cases,out of the 4 cases, the aneurysms were cut and remove the thrombus in the aneurysms and then clipped in 3 cases, another was trapped with bypass of external carotid artery to MCA with great saphenous vein graft. Postoperative angiography was taken in 8 cases, showed that aneurysms was clipped satisfactorily.According to modified GOS, good in 10 cases in the early stage, poor in 1 cases, and 1 died. Conclusions Retrograde suction decompression can make most of paraclinoidal aneurysms deflation, which is helpful for the safe and satisfactory clipping of aneurysms. Intraoperative EEG and SEP monitoring contribute to find early cerebral ischemia and to make sure if the parent artery is narrowed or the normal artery is clipped unexpected.