颅内前循环动脉瘤手术时机与预后探讨.docxVIP

颅内前循环动脉瘤手术时机与预后探讨 中国编辑。 作者：顾建军 鲁峻 高广忠 张勤 蒋霖 刘小星 尹春 殷荣 【摘要】 目的：探讨颅内前循环动脉瘤破裂出血的手术时机及手术后的疗效及脑血管痉挛的 治疗 。方法：颅内前循环动脉瘤破裂出血41例中，蛛网膜下腔出血40例，未破裂动脉瘤1例；Hunt-HessⅠ级9例，Ⅱ级16例，Ⅲ级11例，Ⅳ级3例，Ⅴ级2例；行DSA检查29例，行CTA检查8例，行MRA检查4例，手术采用改良的Yasargil入路。结果：41例患者均成功夹闭动脉瘤。出现血管痉挛、脑梗死致偏瘫、失语3例，有精神症状1例，动眼神经麻痹5例。随访3~24个月，恢复良好35例，轻残2例，重残3例，植物生存1例。结论：早期手术可避免动脉瘤再次出血，减轻脑血管痉挛。Hunt Ⅲ级及以下疗效显著，Ⅳ级以上者术后致残率明显增高。  【关键词】 颅内前循环动脉瘤；蛛网膜下腔出血；显微手术； 脑血管痉挛  [Abstract] Objective：41 cases ruptured intracranial anterior circulation aneurysms performed early microsurgery from January00to December00were analysed ret rospectively，probe the optimal technique of microsurgery for early hemorrhage from intracranial aneurysms，treating method for cerebral vasospasm after operation. Methods：Of these1 cases of intracranial aneurysm，1 case was unruptured intra cranial aneurysms with onset of suffered hemorrhage. All patients were classed by Hunt-Hess. All cases were diagnosed by DSA、CTA or Yasargil’s approach were adopted for all patients. Results：41 cases were completely clipped by aneurysm clips. After clipped，cases showed hemiplegia and aphasia because of cerebral vasospasm and cerebral infarction，one case showed psychiatric showed oculomotor the-month to-year follow -up，3cases recovered well，cases got in mild disability and cases in severe disability，1 cases in Vegetative state，no death in all the1 cases. Conclusion：Early surgery clipped can avoid the rebleeding of aneurysm，relieve cerebral vasospasm. Patients below Hunt-Hess grade Ⅲ showed good effects after operation，those above Hunt-Hess grade Ⅳ showed higher disabling rate.  [Key words] Intracranial aneurysms；Subarachnoid hemorrhage；Microsurgery；Vasospasm  近来颅内动脉瘤的诊断率逐年上升，颅内动脉瘤破裂出血是蛛网膜下腔出血最常见的原因。而颅内动脉瘤破裂出血前很少被发现，有关报道颅内动脉系统的动脉瘤占所有颅内动脉瘤的85%[1]。本文回顾分析XX年1月~XX年12月颅内前循环动脉瘤41例显微手术资料，探讨早期显微手术时机及术式，研究手术后的疗效， 总结 术后并发症治疗方法。  1 临床资料  一般资料 颅内前循环动脉瘤41例中男25例，女16例；年龄9~67岁，平均岁；蛛网膜下腔出血40例，未破裂动脉瘤以上眼睑下垂起病1例；首次出血38例，2次出血2例。临床表现：常