中华神经外科杂志
中華神經外科雜誌
중화신경외과잡지
Chinese Journal of Neurosurgery
2015年
6期
552-556
,共5页
大脑中动脉%颅内动脉瘤%显微外科手术%脑血管重建术%颅内复杂动脉瘤
大腦中動脈%顱內動脈瘤%顯微外科手術%腦血管重建術%顱內複雜動脈瘤
대뇌중동맥%로내동맥류%현미외과수술%뇌혈관중건술%로내복잡동맥류
Middle cerebral artery%Intracranial aneurysm%Microsurgery%Cerebral revascularization%Complex intracranial aneurysm
目的 探讨显微外科手术治疗大脑中动脉(MCA)复杂动脉瘤的方法和疗效.方法 回顾性分析2011年1月至2014年1月天津市环湖医院收治的32例MCA复杂动脉瘤患者的临床资料.动脉瘤直径(24.3 ±6.3)mm;位于MCA M1段8例(近端5例,远端3例),MCA分叉处15例,M2及远端9例.结果 行直接夹闭动脉瘤15例,动脉瘤切除载瘤动脉重塑6例,颅内外动脉搭桥辅助动脉瘤夹闭2例,颅内外动脉搭桥动脉瘤孤立9例.术后恢复良好[格拉斯哥预后分级(GOS)Ⅳ～Ⅴ级]25例(78.1％),效果不良(GOSⅡ～Ⅲ级)6例(18.8％),出院时5例恢复良好,1例重度残疾(GOSⅢ级);死亡1例(3.1％).25例获6～36个月随访,6例失访.25例患者均无动脉瘤再出血;最后一次随访GOS分级Ⅴ级22例,Ⅳ级2例,Ⅲ级1例.26例复查DSA或CTA显示,动脉瘤完全消失21例,部分残留4例(未进一步处理),1例动脉瘤孤立后无明显变化;11例颅内外搭桥和4例载瘤动脉重塑患者吻合血管均通畅.结论 直接手术夹闭仍然是处理MCA复杂动脉瘤的重要手段,对于无法直接夹闭者可行载瘤动脉重建或颅内外血管搭桥.显微手术治疗MCA复杂动脉瘤疗效较好,复发率低.
目的 探討顯微外科手術治療大腦中動脈(MCA)複雜動脈瘤的方法和療效.方法 迴顧性分析2011年1月至2014年1月天津市環湖醫院收治的32例MCA複雜動脈瘤患者的臨床資料.動脈瘤直徑(24.3 ±6.3)mm;位于MCA M1段8例(近耑5例,遠耑3例),MCA分扠處15例,M2及遠耑9例.結果 行直接夾閉動脈瘤15例,動脈瘤切除載瘤動脈重塑6例,顱內外動脈搭橋輔助動脈瘤夾閉2例,顱內外動脈搭橋動脈瘤孤立9例.術後恢複良好[格拉斯哥預後分級(GOS)Ⅳ～Ⅴ級]25例(78.1％),效果不良(GOSⅡ～Ⅲ級)6例(18.8％),齣院時5例恢複良好,1例重度殘疾(GOSⅢ級);死亡1例(3.1％).25例穫6～36箇月隨訪,6例失訪.25例患者均無動脈瘤再齣血;最後一次隨訪GOS分級Ⅴ級22例,Ⅳ級2例,Ⅲ級1例.26例複查DSA或CTA顯示,動脈瘤完全消失21例,部分殘留4例(未進一步處理),1例動脈瘤孤立後無明顯變化;11例顱內外搭橋和4例載瘤動脈重塑患者吻閤血管均通暢.結論 直接手術夾閉仍然是處理MCA複雜動脈瘤的重要手段,對于無法直接夾閉者可行載瘤動脈重建或顱內外血管搭橋.顯微手術治療MCA複雜動脈瘤療效較好,複髮率低.
목적 탐토현미외과수술치료대뇌중동맥(MCA)복잡동맥류적방법화료효.방법 회고성분석2011년1월지2014년1월천진시배호의원수치적32례MCA복잡동맥류환자적림상자료.동맥류직경(24.3 ±6.3)mm;위우MCA M1단8례(근단5례,원단3례),MCA분차처15례,M2급원단9례.결과 행직접협폐동맥류15례,동맥류절제재류동맥중소6례,로내외동맥탑교보조동맥류협폐2례,로내외동맥탑교동맥류고립9례.술후회복량호[격랍사가예후분급(GOS)Ⅳ～Ⅴ급]25례(78.1％),효과불량(GOSⅡ～Ⅲ급)6례(18.8％),출원시5례회복량호,1례중도잔질(GOSⅢ급);사망1례(3.1％).25례획6～36개월수방,6례실방.25례환자균무동맥류재출혈;최후일차수방GOS분급Ⅴ급22례,Ⅳ급2례,Ⅲ급1례.26례복사DSA혹CTA현시,동맥류완전소실21례,부분잔류4례(미진일보처리),1례동맥류고립후무명현변화;11례로내외탑교화4례재류동맥중소환자문합혈관균통창.결론 직접수술협폐잉연시처리MCA복잡동맥류적중요수단,대우무법직접협폐자가행재류동맥중건혹로내외혈관탑교.현미수술치료MCA복잡동맥류료효교호,복발솔저.
Objectives To investigate the methods and efficacy of microsurgical treatment of complex middle cerebral artery (MCA) aneurysms.Method The clinical data of 32 patients with complex MCA aneurysm admitted to Tianjin Huanhu Hospital from January 201 1 to January 2014 were analyzed retrospectively.The aneurysm diameter was 24.3 ± 6.3 mm.The aneurysms of 8 patients were located in the M1 segment of MCA (5 proximal aneurysms and 3 distal aneurysms),15 at the MCA bifurcation,9 at the M2 segment and distal end.Results The aneurysms of 15 patients were clipped directly,6 had aneurysm resection of parent artery for remodeling,2 had extra-and intra-cranial arterial bypass assisted aneurysm clipping,and 9 had extra-and intra-cranial arterial bypass and aneurysm trapping.Postoperative recovery was good (Glasgow outcome scale [GOS] Ⅳ-Ⅴ) in 25 cases (78.1％) and poor in 6 cases (18.8％).Five patients had good recovery at discharge,1 had severe disability (GOS Ⅲ),and 1 died (3.1％).Twenty-five patients were followed up for 6 to 36 months (mean 18 months) and 6 were lost to follow up.None of the 25 patients had aneurysm rebleeding.The GOS score of 22 patients was Ⅴ,2 was Ⅳ,and 1 was Ⅲ at the last follow-up.After procedure,DSA or CTA of 26 patients showed that the aneurysms of 21 patients disappeared completely,4 had aneurysm partial residue (no further treatment),and 1 did not have obvious change after aneurysm trapping.The anastomotic vessels were patent in 11 patients treated with extra-and intra-cranial bypass and 4 treated with parent artery remodeling.Conclusion Direct surgical clipping is still an important means for the management of complex MCA aneurysms,and for those whose aneurysms can not be clipped directly,parent artery reconstruction or extraand intra-cranial vascular bypass can be performed.The efficacy of microsurgery for the treatment of complex MCA aneurysms is good and its recurrence rate is low.
