【作者】 张文清； 黄绳跃； 冯文峰； 漆松涛； 黄为琰； 陈忠仪；

【Author】 ZHANG Weng-qing;HUANG Sheng-yue;FENG Wen-feng;QI Song-tao;HUANG Wei-yan;CHEN Zhong-yi;Department of Neurosurgery,Fujian Medical University Provincial Clinical Medical College,Fujian Provincial Hospital;Department of Neurosurgery,Nan fang Hospital,Southern Medical University;Fujian University of Traditional Chinese Medical;

【机构】 Department of Neurosurgery,Fujian Medical University Provincial Clinical Medical College,Fujian Provincial Hospital； Department of Neurosurgery,Nan fang Hospital,Southern Medical University； Fujian University of Traditional Chinese Medical；

【摘要】 目的:探讨应用杂交手术急诊治疗颅内复杂破裂动脉瘤合并脑内血肿老年患者的初步应用经验。方法:回顾性分析采用杂交手术急诊治疗6例颅内复杂破裂动脉瘤合并脑内血肿的老年患者临床资料。在术中DSA及球囊临时阻断技术辅助下妥善处理动脉瘤及清除血肿,其中,4例动脉瘤行塑形夹闭术,术中DSA造影评估动脉瘤夹闭效果,2例颅内外血管搭桥联合动脉瘤孤立术,术中DSA造影评估桥血管通畅性后行血管内球囊闭塞术孤立动脉瘤。结果在术中DSA及球囊临时阻断技术辅助下,6例患者急诊行杂交手术并清除血肿,术中DSA提示2例需要调整动脉瘤夹,其中1例穿支血管误夹,1例夹闭不全,调整后均夹闭满意。2例颅内外血管搭桥术中造影均通畅,一期行动脉瘤孤立术。术后并发小灶性脑梗死1例,癫痫1例,余患者术后均无新发神经功能障碍。出院时GOS评分:GOS4分4例,3分2例。对6例患者术后3～6个月行临床随访,均无新发神经功能障碍。结论初步观察,应用杂交手术急诊治疗部分未发生脑疝又合并脑内血肿的颅内复杂破裂动脉瘤老年患者是安全且有效。更多还原

【Abstract】 Objective To explore the preliminary experience of the emergency hybrid operation for the treatment of intracranial complex ruptured aneurysms associated with cerebral hematomas for elderly patients.Method Clinical data of 6 elderly patients with intracranial complex ruptured aneurysms associated with cerebral hematomas undergoing hybrid surgery were analyzed retrospectively.With the intraoperative digital subtraction angiography(DSA) and temporary balloon occlusion,the aneurysms were treated and the hematomas were removal appropriately.of whom four aneurysms were treated with intraoperative angiography technique and temporary balloon occlusion assisted shape clipping and evaluate the clipping effect of aneurysms,two patients with aneurysm were treated by intracranial aneurysm isolation combined with extra-intracranial bypass,endovascular balloon occlusion for trapping aneurysms was performed after intraoperative DSA evaluation of the patency of bridge vessel.Results With the intraoperative DSA and temporary balloon occlusion,all the 6 elderly patients were treated with emergency hybrid operation and evacuation of hematoma.The intraoperative DSA revealed that the aneurysm clips needed to be adjusted in 2 patients,including 1 underwent mistakenly clipping of the perforator vessels and 1 with incomplete clipping,after adjustment,the clipping was satisfactory.In intracranial and extracranial bypass surgery of 2 patients,angiography revealed that the blood vessels were patent,trapping of the aneurysms was performed in the one-stage operation.Focal infarction was found in 1 patient and epilepsy in 1 after the operation,other patients had no new neurological dysfunction after operation.The GOS scores at hospital discharge were as follows:GOS 4 in 4 cases and 3 in 2 cases.Six elderly patients were followed up for 6 months after operation.There were no new neurological dysfunctions.Conclusion After preliminary observation,using emergency hybrid operation for the treatment of complicated intracranial ruptured aneurysms associated with intracranial hematomas but without cerebral hernia was safe and effective.更多还原