【作者】 王亮；

【导师】 罗祺；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的:分析病例的临床特点、影像学特点、治疗过程以及术后随访结果,评估支架辅助弹簧圈栓塞术治疗颈内动脉血泡样动脉瘤的疗效,总结相关诊治经验。方法:回顾性分析10例采用支架辅助弹簧圈栓塞术治疗的颈内动脉床突上段血泡样动脉瘤的临床特点、影像学特点、治疗方式及随访结果。本组病例中,男性3例,女性7例,年龄在26~66岁,平均年龄为45.2岁;术前Hunt-Hess分级:Ⅲ级4例,Ⅱ级4例,Ⅳ级2例。Fisher分级:Ⅱ级5例,Ⅲ级4例,Ⅳ级1例。入组病例术前均行DSA检查,确定动脉瘤是出血责任动脉瘤,合理设计手术方案,完善术前准备,行支架辅助弹簧圈栓塞治疗。术后常规行影像学复查并随访。结果:本组10例患者均行支架辅助弹簧圈栓塞术,1例动脉瘤术中破裂出血,但手术成功栓塞动脉瘤;其余9例行支架辅助弹簧圈栓塞术,手术顺利。患者出院时改良Rankin量表(Modified Rankin Scale,m RS)评分为6例1分,2例2分,1例3分,1例4分。3例未行DSA复查,7例复查病例中5例无动脉瘤复发,2例复发。所有患者随访均无再次出血发生。随访2~27个月,平均15.7个月,电话随访提示患者改良Rankin评分为7例0分,2例1分,1例3分。结论:1、支架辅助动脉瘤栓塞术能有效治疗颈内动脉血泡样动脉瘤,降低再出血风险,具有较高的安全性,是治疗BBA的主流趋势;2、支架辅助动脉瘤栓塞术具有一定的复发率,尤其见于首次栓塞不完全患者;3、术后定期复查DSA很有必要,可以发现动脉瘤是否有复发趋势,给予早期干预。更多还原

【Abstract】 Objective: To analysis the clinical features,imaging features,treatment and follow-up results,evaluate the effect of stent-assisted coil embolization in blood blister-like cerebral aneurysms of internal carotid artery,and summarize the experience of diagnosis and treatment.Method: Take retrospective analysis of the clinical features,imaging features,treatment and follow-up visits of 10 cases which treated this disease with stent-assisted coil embolization.It comprised 3 male and 7 female patients in this group,whose mean age was 45.2(range 26-66)years old.Preoperative Hunt-Hess graded Ⅱ in 4 patients,graded Ⅲ in 4 patients and greade Ⅳ in 1 patient.Fisher graded Ⅱ in 5 patients,graded Ⅲ in 4 patients and graded Ⅳ in 1 patient.Before operation,to estimate the aneurysm is responsible of bleeding by DSA examination.Design the operation reasonably and perfect preperative preparation,treating with stent-assisted coil embolization.Carry the DSA examination and follow up the prognosis after treatment.Result: This group of 10 patients underwent stent-assisted coil embolization.1 case occurred aneurysm rupture but aneurysm was achived emblization successfully.Other 9 cases received single stent assisted embolization.At the time of discharge the modified Rankin scores as follows: 1 score in 6 patients,2 score in 2 patients,3 score in 1 patient and 4 score in 1 patient.3 cases did not undergo DSA review.No recurrence was found in 5 cases.Recurrence of aneurysm in 2 cases in review of the cases.No rebleeding occurred in all patients.All the patients were followed up for mean period of 15.7 months,ranged from 2 to 27 months.The modified Rankin scores as follows: 0 score in 7 patients,1 score in 2 patients and 3 score in 1 patient.Conclusion: 1.Stent-assisted embolization is effective in the treatment of blood blister-like aneurysms in the internal carotid artery,it can reduce the risk of rebleeding and have high security.It is the main trend in the treatment of BBA;2.Stent-assisted embolization of aneurysms has a certain recurrence rate,especially in patients with incomplete embolization in the first time;3.It is necessary to review DSA regularly after operation.It can be found whether the aneurysms have recurrence tendency and give early intervention.更多还原