CAJ | 학술논문

目的：探讨大脑中动脉动脉瘤夹闭术后脑梗死的发生原因、机制及其预防措施。方法回顾性分析27例经CT或MRI证实的大脑中动脉动脉瘤夹闭术后脑梗死患者的手术记录及术后的治疗，总结脑梗死的发生时间、发生年龄和发生部位。27例均经翼点入路，开放外侧裂池，充分显露载瘤动脉，解剖出动脉瘤颈部后进行夹闭。结果27例大脑中动脉动脉瘤夹闭术后脑梗死患者发生的年龄偏高，15例出现在术后24 h内，17例位于基底节。随访0．5～2年，恢复良好16例，中残8例，植物生存1例，死亡2例。结论大脑中动脉动脉瘤夹闭术后脑梗死与术中机械性牵拉，血管临时阻断时间过长，阻断部位不当，动脉瘤夹的位置不当及术后血管痉挛引发的迟发性脑缺血有关。熟悉大脑中动脉的解剖，术中准确确定动脉瘤的位置，良好的显微手术技巧，术后采取积极预防措施可以明显降低脑梗死的发生率。
목적：탐토대뇌중동맥동맥류협폐술후뇌경사적발생원인、궤제급기예방조시。방법회고성분석27례경CT혹MRI증실적대뇌중동맥동맥류협폐술후뇌경사환자적수술기록급술후적치료，총결뇌경사적발생시간、발생년령화발생부위。27례균경익점입로，개방외측렬지，충분현로재류동맥，해부출동맥류경부후진행협폐。결과27례대뇌중동맥동맥류협폐술후뇌경사환자발생적년령편고，15례출현재술후24 h내，17례위우기저절。수방0．5～2년，회복량호16례，중잔8례，식물생존1례，사망2례。결론대뇌중동맥동맥류협폐술후뇌경사여술중궤계성견랍，혈관림시조단시간과장，조단부위불당，동맥류협적위치불당급술후혈관경련인발적지발성뇌결혈유관。숙실대뇌중동맥적해부，술중준학학정동맥류적위치，량호적현미수술기교，술후채취적겁예방조시가이명현강저뇌경사적발생솔。
Objective To explore the pathogenetic and prevention of cerebral infarction after middle cerebral artery aneurysm(MCAA) clipping.Methods The clinical data of 27 patients with cerebral infarction confirmed by CT scanning or MRI after the operation were analyzed retrospectively .The occurrence of infarction , the clinical manifestations and the prognosis of these patients were exprienced .All clipping surgery were performed under microscope via pterional approach .Results In 27 patients with cerebral infarction following middle cerebral artery aneurysm clipping, whose ages were elder , 15 of the 27 patients were delected within 24 h after surgery and 17 occuered in the region of basal ganglia .The follow up from 0.5 to 2 years showed 16 patients got good recovery, 8 moderately disabled, 1 in vegetative state and 2 died.Conclusions The occurrence of cerebral infarction after surgery for MCAA clipping is due to brain retraction ,long time for temporary clipping , the location of clipping the artery and clipps application , delayed cerebral perfusion pressure caused by cerebral vasospasm .Knowing the aspects of middle cerebral artery , good exposure and microsurgical techniques , vigorous preventive measures adopted after clipping , the postoperative incidence of the cerebral infarction may be significantly reduced .