【摘要】 目的探讨破裂颅内动脉瘤术中再破裂的预防与处理方法。方法回顾性分析2006年1月至2009年12月经显微手术治疗的89例破裂颅内动脉瘤病人的临床资料。这89例病人中,17例术中发生动脉瘤再破裂,均经采用控制性低血压、沾生物胶的明胶海绵压迫、小功率双极电凝器电灼破裂口和暂时阻断载瘤动脉等方法控制出血后,夹闭瘤颈。结果出院时良好78例,轻残6例,重残3例,死亡2例。其中17例动脉瘤术中再破裂出血均得以有效控制,术后患者恢复优良者15例,轻残1例,死亡1例。结论术前认真细致阅读患者的影像学资料并制订相应的手术策略和应急预案,采用个体化手术入路,以及良好的术中操作技巧可减少颅内动脉瘤的术中再破裂;而术者沉着冷静地采用相应措施,可有效地控制出血,从容夹闭瘤颈。更多还原

【Abstract】 Objective To explore the prevention and treatment of intraoperative rupture of intracranial aneurysm. Methods The clinical data of 89 patients with ruptured intracranial aneurysms undergoing microsurgery from January, 2006 to December, 2009 were ananlyzed retrospectively. The controlled hypotension, oppression with gelatin sponge, temporal occlusion of the parent artery and coagulating the mouth of aneurysmal rupture with bipole electric coagulator were performed and then the aneurysmal necks were clipped in 17 patients who had intraoperative rupture of the aneurysms of these 89 patients with intracranial aneurysms. Results Of 89 patients with intracranial aneurysms, 78 were recovered well, 6 mildly disabled, 3 severely disabled and 2 died. Of 17 patients who had intraoperative rupture of the aneurysms, 15 were recovered well, 1 was mildly disabled and 1 died. Conclusions The intraoperative rupture of the intracranial aneurysms can be decreased or prevented by the accurate preoperative location of the aneurysms, individualized surgical approach, good exposure of the aneurysms and skillful operative technique. The operator’s calmness and the individual clipping method are very important to effective control of intraoperative bleeding due to the aneurysmal rupture in the patients with intracranial aneurysms.更多还原