CAJ | 학술논문

目的探索复合(hybrid)手术室在治疗颅内动脉瘤术中的应用经验.方法 2011年3月至2014年2月天津医科大学总医院神经外科应用复合手术室治疗76例(84个动脉瘤)颅内动脉瘤患者,72例行手术夹闭(其中3例为球囊辅助动脉瘤夹闭),4例行动脉瘤孤立联合高流量搭桥术,术后随访3个月至1年.结果 72例行手术夹闭的患者中,5例(6.9％)术中血管造影显示动脉瘤颈残留,调整动脉瘤夹后再次行术中造影,显示动脉瘤均完全夹闭,其中1例术后6个月血管造影发现动脉瘤复发,行介入栓塞治疗;6例(8.3％)在术中造影显示载瘤动脉狭窄,调整动脉瘤夹后再次行术中造影,5例载瘤动脉狭窄者恢复正常,1例(1.4％)仍存在轻度狭窄,但瘤体过小无法调整,电生理监测未显示异常.4例动脉瘤孤立联合搭桥术者血管均重建成功,术中造影未发现搭桥血管的狭窄或闭塞.随访69例,失访7例.其中53例恢复良好[改良Rankin量表评分(mRS):0分],11例有轻度神经功能障碍(mRS:1～2分),3例重残(mRS:5分),2例死亡(mRS:6分).结论复合手术室能够降低手术相关并发症,提高血管重建成功率,是实现动脉瘤疗效最大化的全新治疗模式.
목적 탐색복합(hybrid)수술실재치료로내동맥류술중적응용경험.방법 2011년3월지2014년2월천진의과대학총의원신경외과응용복합수술실치료76례(84개동맥류)로내동맥류환자,72례행수술협폐(기중3례위구낭보조동맥류협폐),4례행동맥류고립연합고류량탑교술,술후수방3개월지1년.결과 72례행수술협폐적환자중,5례(6.9％)술중혈관조영현시동맥류경잔류,조정동맥류협후재차행술중조영,현시동맥류균완전협폐,기중1례술후6개월혈관조영발현동맥류복발,행개입전새치료;6례(8.3％)재술중조영현시재류동맥협착,조정동맥류협후재차행술중조영,5례재류동맥협착자회복정상,1례(1.4％)잉존재경도협착,단류체과소무법조정,전생리감측미현시이상.4례동맥류고립연합탑교술자혈관균중건성공,술중조영미발현탑교혈관적협착혹폐새.수방69례,실방7례.기중53례회복량호[개량Rankin량표평분(mRS):0분],11례유경도신경공능장애(mRS:1～2분),3례중잔(mRS:5분),2례사망(mRS:6분).결론 복합수술실능구강저수술상관병발증,제고혈관중건성공솔,시실현동맥류료효최대화적전신치료모식.
Objective To explore and summarized the method and experience in the treatment of intracranial aneurysm with application of hybrid operating room.Method Seventy six patients with 84 intracranial aneurysms were surgically treated in Hybrid operating room between March 2011 and March 2014.Aneurysm clipping was performed in 72 cases,Aneurysm trapping with extracranial-intracranial (EC-IC) in 4 cases.Patient demographics,aneurysm size,location,Hunt and Hess score,were recorded.Sixty nine patients were followed up 3-12 months post operation.Results Intraoperative angiography demonstrated residual aneurysm neck in 5 cases (6.9％),readjusting the aneurysm clips again and second intraoperative angiography showed aneurysms were completely clipped.One case was found recurrent aneurysm in 6 months after the repeated angiographic exam and performed interventional embolization treatment; Intraoperative angiography found parent vessel stenosis in 6 cases (8.3％),leading to clip readjustment.in 5 cases with restoration to normal patency and 1 case of no readjustment for aneurysm at too small size to clip adjusted,and no electrophysiological monitoring abnormality; Four cases of aneurysm trapping with EC-IC surgery showed total successful vessel reconstruction (100％).The postoperative outcome was evaluated with the modified Rankin scale (mRS).Fifty-three patients showed good outcome (mRS 0),11 patients showed mild neurological defect (mRS 1-2),3 cases showed poor outcome (mRS 5),and 2 patients died (mRS 6).Conclusion Hybrid operating room provides new concepts in the surgically treatment of intracranial aneurysm,especially valuable for the complex aneurysm.