CAJ | 학술논문

目的探讨大脑中动脉动脉瘤合并外侧裂血肿手术方法.方法回顾性研究2005年1月至2012年2月期间我科收治的大脑中动脉动脉瘤合并外侧裂血肿(血肿量超过20ml)者31例,探寻手术中血肿未完全清除的原因,从解剖及手术技巧探讨手术不足之处.结果原因包括术前切口设计骨窗偏小,清除血肿时颞叶前部皮层切口过短,及动脉瘤夹闭成功后对外侧裂血肿清除重视不足；另外对于动脉瘤及重要分支附近某些“早期机化”质地较硬的血肿过度清除,导致分支损伤术后继发出血.结论头皮及颞叶皮层切口可以向颞后部适当扩大或延长,对于血肿清除有利；对于个别粘附在动脉瘤及载瘤动脉重要分支附近的“机化样”血块,适度清除.
목적 탐토대뇌중동맥동맥류합병외측렬혈종수술방법.방법 회고성연구2005년1월지2012년2월기간아과수치적대뇌중동맥동맥류합병외측렬혈종(혈종량초과20ml)자31례,탐심수술중혈종미완전청제적원인,종해부급수술기교탐토수술불족지처.결과 원인포괄술전절구설계골창편소,청제혈종시섭협전부피층절구과단,급동맥류협폐성공후대외측렬혈종청제중시불족；령외대우동맥류급중요분지부근모사“조기궤화”질지교경적혈종과도청제,도치분지손상술후계발출혈.결론 두피급섭협피층절구가이향섭후부괄당확대혹연장,대우혈종청제유리；대우개별점부재동맥류급재류동맥중요분지부근적“궤화양”혈괴,괄도청제.
Objective To study surgical treatment for middle cerebral aneurysm (MCA) with intracerebral hematoma around the lateral fissure.Methods 31 cases of MCA with intracerebral hematoma (volume of hematoma was more than 20ml) around the lateral fissure were treated surgically in our hospital from January 2005 to February 2012.Their clinical data were colleted and the surgical shortages were studied from the aspects of anatomy and surgical techniques.Results The surgical shortages included:The bone window was too small due to poor preoperational incision design; The incision of anterior temporal cortex was too short when eliminating hematoma; Insufficient attention was paid to the elimination of intracerebral hematoma occurred after successful aneurysm occlusion ; The bleeding wasn1 stopped carefully ; Some "early organized" hematomas with hard texture near the aneurysm and important branches were excessively eliminated,thus leading to branch injury.Conclusions The incisions of scalp and temporal cortex should be properly enlarged or extended to the direction of posterior temporal lobe,which is beneficial to the clearance of temporal hematoma.Some "organized" hematomas adhering to the aneurysm and near the important branches of parent artery should be cleared appropriately.