CAJ | 학술논문

目的探讨前循环破裂动脉瘤急诊手术处理的注意事项.方法对1996年6月至2011年10月期间无锡解放军一○一医院因前循环动脉瘤破裂而住院的508例急诊患者的临床资料进行回顾性分析.结果 508例患者均在蛛网膜下腔出血3d内手术,采用额颞入路或标准翼点入路503例,经前纵裂入路5例;508例中去骨瓣减压55例.手术动脉瘤瘤颈夹闭453例,夹闭加包裹32例,中动脉动脉瘤孤立加颞浅动脉和大脑中动脉搭桥手术5例,早年行单纯包裹18例.其中同侧多发性动脉瘤一次手术夹闭2个动脉瘤35例,双侧多发动脉瘤早年多夹闭处理出血的责任动脉瘤22例.术中吲哚菁绿(ICG)荧光血管造影89例,10例调整瘤夹位置瘤颈获得满意夹闭,术后常规行CTA检查.所有患者均经过0.5 -15年的随方,良好361例,中残59例,重残42例,植物生存14例,死亡和自动出院32例.结论对于前循环破裂动脉瘤Hunt - Hess Ⅰ～Ⅲ级的患者急诊手术,Ⅳ～Ⅴ级伴血肿或急性脑积水和脑室积血的患者也应急诊手术同时行去骨瓣减压或脑室引流;急诊CTA可作为其首选常规筛查手段;术中ICG荧光造影可作为有效的辅助监测手段.
목적 탐토전순배파렬동맥류급진수술처리적주의사항.방법 대1996년6월지2011년10월기간무석해방군일○일의원인전순배동맥류파렬이주원적508례급진환자적림상자료진행회고성분석.결과 508례환자균재주망막하강출혈3d내수술,채용액섭입로혹표준익점입로503례,경전종렬입로5례;508례중거골판감압55례.수술동맥류류경협폐453례,협폐가포과32례,중동맥동맥류고립가섭천동맥화대뇌중동맥탑교수술5례,조년행단순포과18례.기중동측다발성동맥류일차수술협폐2개동맥류35례,쌍측다발동맥류조년다협폐처리출혈적책임동맥류22례.술중신타정록(ICG)형광혈관조영89례,10례조정류협위치류경획득만의협폐,술후상규행CTA검사.소유환자균경과0.5 -15년적수방,량호361례,중잔59례,중잔42례,식물생존14례,사망화자동출원32례.결론 대우전순배파렬동맥류Hunt - Hess Ⅰ～Ⅲ급적환자급진수술,Ⅳ～Ⅴ급반혈종혹급성뇌적수화뇌실적혈적환자야응급진수술동시행거골판감압혹뇌실인류;급진CTA가작위기수선상규사사수단;술중ICG형광조영가작위유효적보조감측수단.
Objective To explore emergency surgical treatment of ruptured anterior circulation aneurysms.Methods The clinical data of 508 patients with ruptured anterior circulation aneurysms were retrospectively analyzed between June 1996 to October 2011. Among which 503 were operated by frontotemporal approach or by pterional approach,5 by anterior interhemispheric approach.55 were romove the bone clack in order to depress intracranial pressure(ICP).Results After a follow - up of 6 months to 15 years and According to GOS classification,361 were of grade Ⅰ,59 of grade 1],42 of grade ]Ⅲ,14 of grade Ⅳ,32 of grade Ⅴ. Conclusions Emergency surgical treatment of ruptured anterior circulation aneurysms in patients of Hunt - Hess grade Ⅰ - Ⅲ and Ⅳ - Ⅴ concomitant brain hematoma、acute hydrocephalus or cerebral ventricles hematocele may lead to favorable outcomes.Emergency CTA should be the most important screening method.ICG angiography is an important method in monitoring aneurysm clip perfectly and exactly.