临床神经外科杂志
臨床神經外科雜誌
림상신경외과잡지
JOURNAL OF CLINICAL NEUROSURGERY
2014年
2期
118-121
,共4页
张清平%陈建良%冯文峰%漆松涛%邱建东%游恒星%马珊%钟远强%练晓文%彭智涛
張清平%陳建良%馮文峰%漆鬆濤%邱建東%遊恆星%馬珊%鐘遠彊%練曉文%彭智濤
장청평%진건량%풍문봉%칠송도%구건동%유항성%마산%종원강%련효문%팽지도
颅内动脉瘤%脑内血肿%显微手术%前循环
顱內動脈瘤%腦內血腫%顯微手術%前循環
로내동맥류%뇌내혈종%현미수술%전순배
intracranial aneurysm%intracerebral hematomas%microsurgery%anterior circulating
目的：探讨前循环动脉瘤破裂伴脑内血肿手术方法及疗效。方法前循环动脉瘤破裂并脑内血肿患者29例行显微手术治疗，总结其临床特点：动脉瘤部位、大小、形态、合并脑内血肿大小、形态，术前Hunt-Hess分级、手术方式及三个月随访的格拉斯预后评分。结果 Hunt-Hess分级Ⅲ级10例、Ⅳ级17例、Ⅴ级2例。17例患者术前经常规血管造影，12例行三维CT血管造影（3D-CTA）检查证实。29例术中诊断与术前诊断一致，前交通动脉瘤6例，后交通动脉瘤7例，大脑中动脉瘤16例，29例患者共31枚动脉瘤均成功夹闭，3个月后随访时GOS评分Ⅴ级14例，Ⅳ级7例，Ⅲ级4例，Ⅱ级2例，Ⅰ级2例。结论颅内前循环动脉瘤破裂并脑内血肿患者病情危重，早期夹闭动脉瘤，清除血肿，效果良好。
目的：探討前循環動脈瘤破裂伴腦內血腫手術方法及療效。方法前循環動脈瘤破裂併腦內血腫患者29例行顯微手術治療，總結其臨床特點：動脈瘤部位、大小、形態、閤併腦內血腫大小、形態，術前Hunt-Hess分級、手術方式及三箇月隨訪的格拉斯預後評分。結果 Hunt-Hess分級Ⅲ級10例、Ⅳ級17例、Ⅴ級2例。17例患者術前經常規血管造影，12例行三維CT血管造影（3D-CTA）檢查證實。29例術中診斷與術前診斷一緻，前交通動脈瘤6例，後交通動脈瘤7例，大腦中動脈瘤16例，29例患者共31枚動脈瘤均成功夾閉，3箇月後隨訪時GOS評分Ⅴ級14例，Ⅳ級7例，Ⅲ級4例，Ⅱ級2例，Ⅰ級2例。結論顱內前循環動脈瘤破裂併腦內血腫患者病情危重，早期夾閉動脈瘤，清除血腫，效果良好。
목적：탐토전순배동맥류파렬반뇌내혈종수술방법급료효。방법전순배동맥류파렬병뇌내혈종환자29례행현미수술치료，총결기림상특점：동맥류부위、대소、형태、합병뇌내혈종대소、형태，술전Hunt-Hess분급、수술방식급삼개월수방적격랍사예후평분。결과 Hunt-Hess분급Ⅲ급10례、Ⅳ급17례、Ⅴ급2례。17례환자술전경상규혈관조영，12례행삼유CT혈관조영（3D-CTA）검사증실。29례술중진단여술전진단일치，전교통동맥류6례，후교통동맥류7례，대뇌중동맥류16례，29례환자공31매동맥류균성공협폐，3개월후수방시GOS평분Ⅴ급14례，Ⅳ급7례，Ⅲ급4례，Ⅱ급2례，Ⅰ급2례。결론로내전순배동맥류파렬병뇌내혈종환자병정위중，조기협폐동맥류，청제혈종，효과량호。
Objective To explore microsurgical techniques and curative effects of anterior circulation aneurysms with intracerebral haematoma .Methods 29 patients with ruptured anterior circulation aneurysms with intracerebral hematomas underwent haematoma evacuation and aneurysmal clipping.The clinical features , including the location , size, shape of the aneurysm , the combined intracerebral hematoma size ,shape,preoperative Hunt-Hess grade,GOS in three-month follow-up,were summrized.Results Hunt-Hess gradeⅢwere 10 cases,Ⅳ17 andⅤ2.17 patients with preoperative digital subtraction angiography , 12 three-dimensional CT angiography ( 3D-CTA ) confirmed.The microsurgical outcomes indicated that the intraoperative diagnoses were consistent with preoperative diagnoses in all cases .The ruptured aneurysms include 6 cases of anterior communicating artery aneurysms ,7 posterior communicating artery aneurysms , and 16 middle cerebral artery aneurysms .29 patients with a total of 31 aneurysms were clipped successfully .GOS in three-month follow-up were gradeⅴin 14 cases,grade Ⅳin 7,grade Ⅲin 4,gradeⅡin 2 and gradeⅠin 2.Conclusion For patients with ruptured aneurysms of anterior circlulation combined with intracerebral hematoma , favorable outcome should be achieved through early clipping of the aneurysm , remove the hematoma .
