摘要
目的 评价复合手术夹闭颈内动脉床突旁大型和巨大型动脉瘤的临床应用价值与效果.方法 回顾性分析2014年1月至2017年3月首都医科大学宣武医院神经外科在复合手术室应用球囊辅助手术夹闭8例（11个动脉瘤）颈内动脉床突旁大型和巨大型未破裂动脉瘤患者的临床资料.8例患者均为女性,平均年龄为（54.9±5.7）岁.结果 本组11个动脉瘤共9个动脉瘤接受了治疗,包括8个大型或巨大型床突旁动脉瘤,1个颈动脉窝动脉瘤.术中造影提示9个动脉瘤完全闭塞,1个载瘤动脉闭塞,1个载瘤动脉重度狭窄.术后3例发生缺血性卒中.出院时的格拉斯哥预后分级（GOS）：恢复良好（Ⅴ级）5例,轻度残疾（Ⅳ级）1例,重度残疾（Ⅲ级）2例.术后随访1.5～39.5个月,中位随访时间为10.7（P25：3.2,P75：32.3）个月,GOS Ⅴ级7例,Ⅳ级1例.7例患者的视力改善,1例稳定.结论 复合手术有利于颈内动脉床突旁大型或巨大型动脉瘤的夹闭,但仍需要探索合适的介入器械和方法.
Objective To evaluate the clinical value and outcomes of surgical clipping for large and giant unruptured paraclinoid aneurysms.Methods A retrospective analysis was conducted on 8 patients （11 aneurysms） who underwent aneurysm clipping assisted with balloon occlusion in hybrid operation theatre at Neurosurgery Department of Xuanwu Hospital,Capital Medical University,from January 2014 to March 2017.All patients were females whose average age was 54.9 ± 5.7 years.Results Among 11 aneurysms in this series,a total of 9 aneurysms were treated and included 8 large or giant paraclinoid aneurysms and 1 carotid cave aneurysm.Intraoperative radiography demonstrated that all 9 aneurysms were successfully obliterated,1 patient developed occlusion of parent artery and 1 had severe stenosis of parent artery.Three patients encountered ischemic events postoperatively.The assessment at discharge indicated a Glasgow Outcome Score （GOS） of 5 in 5 patients,4 in 1 case and 3 in 2 cases.At the follow-up which was conducted 1.5-39.5 [average：10.7 （P25：3.2,P75：32.3）] months post operation,a GOS of 5 was reported 7 patients and 4 in 1 case.Vision acuity was improved in 7 patients and remained stable in 1 case.Conclusion Hybrid surgery seems to be able to facilitate clipping of large and giant unruptured paraclinoid aneurysms,but more studies are needed for exploration of proper interventional devices and methods.
出处
《中华神经外科杂志》
CSCD
北大核心
2017年第8期770-774,共5页
Chinese Journal of Neurosurgery
基金
国家重点研发计划（2016YFC1300800）
中国脑卒中高危人群干预适宜技术研究及推广项目（GN-2016R0004）
关键词
颅内动脉瘤
颈内动脉
床突旁
复合手术
球囊阻断
开颅夹闭术
Intracranial aneurysm
Carotid artery,internal
Paraclinoid
Hybrid operation
Balloon occlusion
Surgical clipping
