床突旁动脉瘤的手术治疗(附21例报告).pdfVIP

　 军 杂 20 14年7月1 日　第39卷　第7期 562 解放 医学 志　 论　著 床突旁动脉瘤的手术治疗(附2 1例报告) 王守森，赵清爽，林顺安，赵琳，张小军，王如密 [摘要]　目的　探讨床突旁动脉瘤的直接手术策略。方法　回顾性分析2007年1月－20 13年1月经直接手术处理的 2 1例床突旁动脉瘤患者的临床资料，总结直接手术的经验及教训。结果　2 1例患者中，男8例，女13例，年龄29 ～72 岁，中位年龄47岁。手术前Hunt-Hess分级0级5例，Ⅰ级8例，Ⅱ级3例，Ⅲ级4例，Ⅳ级1例。小型动脉瘤7个，中型动 脉瘤9个，大型动脉瘤5个，均属于囊状动脉瘤。2 1例患者均采用经翼点入路手术，其中15例采用颈部切口控制颈动 脉，12例磨除了前床突。20例获得满意夹闭，1例血泡样动脉瘤未能夹闭并于术后死亡。结论　成功夹闭床突旁动脉 瘤可以获得良好的临床效果。有效地控制颈段颈内动脉和磨除前床突是基本的手术技术，良好的动脉瘤显露和准确的 瘤夹型号选择也同样重要。 [关键词]　颅内动脉瘤；眼动脉；显微外科手术 [中图分类号]　R65 1. 122　　　　[文献标志码]　A　　　　[文章编号]　0577-7402 (20 14 )07-0562-06 [D OI]　10. 11855/j.issn.0577-7402.20 14.07. 10 Surgical treatment of paraclinoid aneurysms: a report of 21 cases WANG Shou-sen, ZHAO Qing-shuang, LIN Shun-an, ZHAO Lin, ZHANG Xiao-jun, WANG Ru-mi Department of Neurosurgery, Fuzhou General Hospital of Nanjing Command, Fuzhou 350025, China [A b stract]　Obj ectiv e　To inv estigate th e strategy of direct surgi cal treatm ent f or p araclin oi d an eury sms. M eth ods　 Clinical data of 2 1 cases of paraclinoid aneury sms hav ing receiv ed direct surgery from J anuary 2007 to J anuary 20 13 w ere rev iew ed retrosp ectiv ely, and th e op erativ e exp erience and lessons learned w ere summarized. Results　A mong 2 1 patients, th ere w ere 8 males and 13 femal es, aged 29-72 y ears (median age 47 y ears). A mong th em, 5 patients w ere found to b e Hunt-Hess grade 0, 8 patients w ere Hunt-Hess grade Ⅰ, 3 w ere Hunt-Hess grade Ⅱ, 4 w ere Hunt-Hess grade Ⅲ, and 1 w as Hunt-Hess grade Ⅳ b efore op eration. All th e aneury sms in this group w ere saccular in form, and th eir size v aried from 5mm (small) in 7, 5- 15mm (median) in 9, and 15- 25mm (large) in 5. Standard transpterygoid craniotomy w as p erformed in all patients. Cerv ical internal carotid artery w as exp osed for controlling bleeding in 15 cases,