摘要
目的总结颅内动脉瘤的显微手术治疗和并发症防治的经验。方法回顾性分析2006年3月至2010年3月期间收治的59例颅内动脉瘤患者的临床资料、手术方式、预后及并发症。结果全组59例共62个动脉瘤。3例因年龄等因素拒绝手术,其余56例均接受手术治疗,其中行显微镜下成功夹闭动脉瘤57个,动脉瘤孤立术1个,巨大动脉瘤瘤腔明胶海绵填塞术1个,手术过程顺利。术后随访3个月以上,生存质量根据日常生活能力(ADL)分级评分:Ⅰ～Ⅱ级47例(83.9%),Ⅲ～Ⅳ级3例(5.4%),Ⅴ～Ⅵ级3例(5.4%),Ⅶ级1例(1.8%),死亡2例(3.6%)。结论数字减影血管造影(DSA)及CT血管造影(CTA)均可有效诊断颅内动脉瘤。早期显微手术夹闭是治疗颅内破裂动脉瘤的有效方法。翼点入路仍是颅内动脉瘤最常用的手术入路,能明显提高破裂动脉瘤患者的生存率和生存质量。术后积极防治并发症是治疗成功的关键。
Objective To sum up the experience of microsurgical treatment and complication prevention for intracranial aneurysm. Methods A series of 59 cases of patients with 62 aneurysms were examined. Author retrospectively analyzed the data of clinical information, surgical approach, prognosis and complication of these patients. Results 3 patients refused to take operation because of advanced age and some other risk factors. Other 56 cases underwent microsurgical therapy. The aneurysms were directly clipped during microsurgery in 57 of them, one had aneurysm trapping, and one with giant aneurysm underwent intracavitary embolization using gelfoam. All the operations were successful and went smoothly. The quality of life in patients 〉 3 months postoperation was evaluated using activity of daily living （ADL） scale. 47 cases of patients （83.9%） showed ADL stage I - 1I , 3 cases of patients （5.4%） showed ADL stage Ill-IV, other 3 cases （5.4%） and 1 case（ 1.8% ） presented ADL stageV-VI and stage VII, respectively. Beyond that, 2 patients of them （3.6%） were dead af- ter surgical treatment. Conclusions Both digital subtraction angiography （DSA） and CT angiography （CTA） offers high diagnostic accuracy in detection of intracranial aneurysms. Early microsurgery for clipping ruptured intracranial aneurysms was effective. The trans-pterional approach, most commonly used in microsurgery for aneurysms, could significantly increase the survival and quality of life in patients with ruptured aneurysms. Active complication prevention after operation is crucial for the treatment results.
出处
《中国肿瘤外科杂志》
CAS
2011年第6期329-331,359,共4页
Chinese Journal of Surgical Oncology
关键词
颅内动脉瘤
显微手术治疗
手术入路
手术时机
瘤颈夹闭
术后并发症
intracranial aneurysm
microsurgical treatment
surgical approach
timing of surgery
tumor neck clipping
postoperative complication
