CAJ | 학술논문

目的探讨动脉瘤体穿刺减压技术在颅内大型及巨大型动脉瘤夹闭术中的作用.方法本组25例颅内大型及巨大型动脉瘤,根据部位不同,采用不同的动脉瘤近端暴露方法.位于颈内动脉-眼动脉段的动脉瘤,采用颈部颈内动脉暴露然后行翼点开颅术,颈内动脉-后交通动脉以上的动脉瘤,直接行翼点开颅术.临时阻断颈部颈内动脉或载瘤动脉近端及远端和分支,行动脉瘤体穿刺吸引器吸除血液减压,待动脉瘤压力降低后行动脉瘤夹闭术;对于血栓性大型及巨大型动脉瘤,将载瘤动脉近、远端及其分支临时阻断后行动脉瘤体切开取栓、动脉瘤夹闭术.在动脉瘤夹闭前后,使用微血管多普勒(MVD)予以监测.结果手术中血管临时阻断时间9～15 min,平均11 min;动脉瘤夹闭后MVD监测动脉瘤体部涡流消失,载瘤动脉及其分支血流通畅;手术后经CTA或DSA检查,动脉瘤消失,血流正常.结论载瘤动脉近、远端及其分支临时阻断、动脉瘤体穿刺(或切开取栓)减压的动脉瘤夹闭术适用于颅内绝大多数大型与巨大型动脉瘤(包括血栓性动脉瘤);术中使用MVD予以监测,将保证手术安全,提高手术治疗效果.
목적 탐토동맥류체천자감압기술재로내대형급거대형동맥류협폐술중적작용.방법 본조25례로내대형급거대형동맥류,근거부위불동,채용불동적동맥류근단폭로방법.위우경내동맥-안동맥단적동맥류,채용경부경내동맥폭로연후행익점개로술,경내동맥-후교통동맥이상적동맥류,직접행익점개로술.림시조단경부경내동맥혹재류동맥근단급원단화분지,행동맥류체천자흡인기흡제혈액감압,대동맥류압력강저후행동맥류협폐술;대우혈전성대형급거 대형동맥류,장재류동맥근、원단급기분지림시조단후행동맥류체절개취전、동맥류협폐술.재동맥류협폐전후,사용미혈관다보륵(MVD)여이감측.결과 수술중혈관림시조단시간9～15 min,평균11 min;동맥류협폐후MVD감측동맥류체부와류소실,재류동맥급기분지혈류통창;수술후경CTA혹DSA검사,동맥류소실,혈류정상.결론 재류동맥근、원단급기분지림시조단、동맥류체천자(혹절개취전)감압적동맥류협폐술괄용우로내절대다수대형여거대형동맥류(포괄혈전성동맥류);술중사용MVD여이감측,장보증수술안전,제고수술치료효과.
Objective To explore the role of puncturing the aneurysm to decompress in clipping intracranial large and giant aneurysms.Methods Different methods were used according to the different location of 25 cases of large and giant aneurysms.Cervical carotid internal artery was exposed and the pterional craniotomy was used for carotid-ophthalmic aneurysm,and direct pterion craniotomy used in the carotid-post communicating artery aneurysm.Temporary occluded the exposed the cervical internal carotid artery or the intracranial proximal segment of parent artery and distal segment of parent artery and its branches,then punctured aneurysm body and suck gushing blood with suction.When aneurysm body collapsed,remodel the parent artery and clipped aneurysm.As a thrombotic giant aneurysm which was incised then removed thrombus and clipped aneurysm after parent artery and its branches have been occluded provisionally.Microvascular doppler (MVD) was used to monitor before and after clipped aneurysms.Results The time of temporary occlusion vessels was 9-15 minutes.,the average time was 11 minutes.MVD monitor showed vortex flow disappearance of aneurysm and the bloodstream amplitude of the parent artery and its branches were not changed before and after clip.Postoperative DSA or CTA showed aneurysms disappeared and the bloodstream of the parent artery and its branches were normal after operation.Conclusions The temporary occlusion of the parent artery and its branches and the direct puncture of aneurysm body (or incise aneurysm and remove thrombus) to decompress are indicated for the most large and giant aneurysms (including thrombotic aneurysm).MVD is of benefit in providing operative safe and improving treatment effects in aneurysm surgery.