CAJ | 학술논문

目的探讨早、中期显微手术治疗颅内动脉瘤破裂的方法,讨论术中、术后出现的并发症及治疗方法.方法回顾性分析36例颅内动脉瘤患者临床资料,入院前均经头颅CT检查证实有蛛网膜下腔出血存在,35例患者经全脑血管造影检查证实为颅内动脉瘤,1例经手术探查证实右侧A2段动脉瘤.36例患者均在早、中期进行显微手术治疗.早期蛛网膜下腔出血后3 d内手术22例,中期蛛网膜下腔出血后4～10 d内手术14例.结果格拉斯哥预后评分Ⅰ级21例,Ⅱ级4例,Ⅲ级4例,Ⅳ级4例.术后均复查头颅CT,无术后颅内血肿,不同部位脑梗死5例.死亡3例,1例为后交通动脉动脉瘤夹闭后发生枕叶梗死,发生脑疝,家属放弃治疗;1例为Hunt-Hess Ⅴ级的前交通动脉瘤患者,术后脑疝症状未解除:1例为前交通动脉瘤栓塞术后2年再发出血,手术夹闭后1周突发枕骨大孔疝.术后26例患者行全脑血管造影复查,1例患者提示前交通动脉瘤完全未被夹闭,1例后交通动脉瘤有残颈,1例后交通动脉瘤患者示后交通动脉未显影.结论早、中期显微手术是治疗颅内动脉瘤的有效方法.术后脑缺血是颅内动脉瘤手术的严重并发症,特别是颈内动脉后交通段动脉瘤,术中对后交通动脉的保护十分重要.对载瘤动脉及动脉瘤体内血栓形成或粥样硬化患者的手术治疗还需进一步研究.
목적 탐토조、중기현미수술치료로내동맥류파렬적방법,토론술중、술후출현적병발증급치료방법.방법 회고성분석36례로내동맥류환자림상자료,입원전균경두로CT검사증실유주망막하강출혈존재,35례환자경전뇌혈관조영검사증실위로내동맥류,1례경수술탐사증실우측A2단동맥류.36례환자균재조、중기진행현미수술치료.조기주망막하강출혈후3 d내수술22례,중기주망막하강출혈후4～10 d내수술14례.결과 격랍사가예후평분Ⅰ급21례,Ⅱ급4례,Ⅲ급4례,Ⅳ급4례.술후균복사두로CT,무술후로내혈종,불동부위뇌경사5례.사망3례,1례위후교통동맥동맥류협폐후발생침협경사,발생뇌산,가속방기치료;1례위Hunt-Hess Ⅴ급적전교통동맥류환자,술후뇌산증상미해제:1례위전교통동맥류전새술후2년재발출혈,수술협폐후1주돌발침골대공산.술후26례환자행전뇌혈관조영복사,1례환자제시전교통동맥류완전미피협폐,1례후교통동맥류유잔경,1례후교통동맥류환자시후교통동맥미현영.결론 조、중기현미수술시치료로내동맥류적유효방법.술후뇌결혈시로내동맥류수술적엄중병발증,특별시경내동맥후교통단동맥류,술중대후교통동맥적보호십분중요.대재류동맥급동맥류체내혈전형성혹죽양경화환자적수술치료환수진일보연구.
Objective To explore the microsurgical method in treating ruptured aneurysms treatment and evaluating the treatment of the complication during or after the operation.Methods 36 cases of patients with intracranial aneurysm were analyzed retrospectively.All of the patients were subarachnoid hemorrhage (SAH) by CT scan on admission.The intracranial aneurysms were confirmed in 35 cases by DSA examination and A2 aneurysm was confirmed by explorative operation in 1 case.The microsurgical treatment was performed in 36 cases at the early or intermediate stage,22 cases were treated in the early stage,the other 14 cases were treated in the intermediate stage (early stage means within 3 days post SAH;intermediate stage means from 4 days to 10 days post SAH).Results After the operation,21 cases were GOS grade Ⅰ,4 cases were COS grade Ⅱ,4 cases were COS grade Ⅲ,4 cases were GOS grade Ⅳ.Of all the patients,CT scan was done after the operation,finding no intracranial bemorrhage,and cerebral infarction was disclosed in 5 cases.3 cases were dead,one suffered occipital lobe infaret after the PCoA aneurysm clipped,brain hernia occurred at last,one's Hunt Hess grade was Ⅴ,ACoA aneurysm was disclosed by DSA examination,severe brain edema occurred after the operation,the other suffered tonsillar hernia one week after the aneurysm clipping,which ruptured after endovascular treatment of ACoA aneurysm 2 years later.DSA examinations were done in 26 cases after operation,declaring 1 ACoA aneurysm was unclipped,1 PCoA aneurysm was incompletely clipped,and 1 PCoA was sacrificed.Conclusions It is a valuable method to clip the ruptured intracranial aneurysms in early and intermediate stage.The cerebral ischemia is the severe complication after clipping.Especially for the PCoA aneurysms,it is very important to protect the PCoA.Further research should be done for the treatment in the case with mother artery arteriosclerosis and thrombosis within the aneurysms.