CAJ | 학술논문

目的分析破裂后颅内动脉瘤血管内栓塞手术相关并发症的发生原因及防治方法. 方法 68例破裂后颅内动脉瘤采用早期血管内栓塞治疗,术中对动脉痉挛采用经微导管灌注罂粟碱或球囊扩张解痉:对弹簧圈堵塞载瘤动脉采用抗凝或抗血小板治疗:对动脉瘤破裂采用中和肝素继续栓塞;对动脉血栓形成采用栓塞后经微导管灌注r-tPA溶栓. 结果 68例中出现并发症8例,占11.77%.其中大脑中动脉广泛性痉挛1例,出现脑梗死,轻度偏瘫;局限性痉挛2例,治疗后无后遗症;弹簧圈部分进入大脑中动脉1例,治疗后无脑梗死;弹簧圈脱落脑梗死1例,术中动脉瘤破裂1例,继续栓塞无不良后果;术后1周动脉瘤再次破裂死亡1例;血栓形成大面积脑梗死偏瘫1例. 结论清楚显示动脉瘤的部位、形态、大小以及与载瘤动脉的关系有助于栓塞的成功;合理选择弹簧圈规格及熟练掌握操作技术能降低并发症的发生率;术中及时妥当处理并发症可明显改善预后情况.
목적 분석파렬후로내동맥류혈관내전새수술상관병발증적발생원인급방치방법. 방법 68례파렬후로내동맥류채용조기혈관내전새치료,술중대동맥경련채용경미도관관주앵속감혹구낭확장해경:대탄황권도새재류동맥채용항응혹항혈소판치료:대동맥류파렬채용중화간소계속전새;대동맥혈전형성채용전새후경미도관관주r-tPA용전. 결과 68례중출현병발증8례,점11.77%.기중대뇌중동맥엄범성경련1례,출현뇌경사,경도편탄;국한성경련2례,치료후무후유증;탄황권부분진입대뇌중동맥1례,치료후무뇌경사;탄황권탈락뇌경사1례,술중동맥류파렬1례,계속전새무불량후과;술후1주동맥류재차파렬사망1례;혈전형성대면적뇌경사편탄1례. 결론 청초현시동맥류적부위、형태、대소이급여재류동맥적관계유조우전새적성공;합리선택탄황권규격급숙련장악조작기술능강저병발증적발생솔;술중급시타당처리병발증가명현개선예후정황.
Objective To analyze the cause, prevention and treatment of complications related to endovascular embolotherapy for ruptured intracranial aneurysms. Methods Sixty-eight patients with ruptured intracranial aneurysms received early endovascular embolization. Intraoperatively, artery spasm was relieved by papaverine infusion through microcatheter or balloon dilatation; parent artery occlusion by coils was treated by anticoagulation or antiplatelet treatment; ruptured aneurysms were embolized using mixed heparin; arterial thrombosis after embolization was ameliorated by the micro-catheter infusion of r-tPA thrombolytic. Results In the 68 cases, 8 cases suffered from complications, accounting for 11.77%. Among them, 1 case of extensive spasm of middle cerebral artery developed cerebral infarction and mild hemiplegia; 2 cases of localized spasm were improved well without sequelae; 1 case in which partial coils entered middle cerebral artery achieved a satisfied therapeutic outcome without infarction; 1 case with cerebral infarction due to coil dropping and 1 case with aneurysm rupture during operation received secondary embolotherapy without adverse consequences; one week after operation, 1 case died from aneurysm re-rupture; 1 case had hemiplegia owing to massive cerebral infarction. Conclusions It will do much benefit to secure the success of the operation by displaying the location, shape and size of the aneurysms as well as the relationship with the parent artery. Moreover, the proper choice of coils and well mastering of operative skills can decrease the incidence of complications, and adequate and prompt treatment of intraoperative complications can improve the prognosis of the patients obviously.