作　　者： (王振宇）; (黄光富）; (张天）; (李志立）; (谭海斌）; (刘灵童）;

机构地区： 四川省医学科学院·四川省人民医院,四川成都610072

出　　处： 《西部医学》 2017年第9期1281-1284,1287,共5页

摘　　要： 目的探讨大脑中动脉瘤夹闭手术治疗方案的选择。方法回顾性分析2014年6月~2016年6月收治的121例147个大脑中动脉瘤夹闭手术治疗患者,平均年龄59.3岁;大脑中动脉M1段动脉瘤19个,中动脉分叉处动脉瘤95个,远端动脉瘤33个。依据动脉瘤瘤颈的大小、瘤颈壁结构(硬化、钙化)、瘤囊的大小、瘤囊内是否有血栓、钙化、瘤囊上有无重要分支血管等分别采用单纯夹闭、塑形夹闭和血管重建三种手术方法。结果 147个大脑中动脉瘤中48个大脑中动脉瘤选用单纯夹闭手术,91个动脉瘤选择塑形夹闭,8例巨大动脉瘤术中颅内外血管搭桥动脉瘤孤立或近端夹闭(血管重建),三种方法并发症及格拉斯哥预后评分无统计学差异(P>0.05),术后并发症分别为10.4%、14.3%、12.5%,塑形夹闭患者并发症发生率稍高,并有3.3%的复发率。结论三种手术方式术后并发症和预后虽无统计学差异,但临床医生术前仍应综合影像资料详细分析,根据动脉瘤的瘤囊的具体情况,选择最佳治疗方案。 Objective To explore treatment options for middle cerebral aneurysm clipping surgery. Methods From June 2014 to june2016,the clinical and radiological data of 121 patients with 147 middle cerebral artery （MCA） aneurysms clipping surgery were retrospectively analyzed. There were 19 aneurysms located at M1 segment of MCA, 95 aneurysms at the main MCA bifurcation and 33 aneurysms at distal MCA. Surgical schemes were selected according to the size of the aneurysm neck and neck wall structure （sclerosis, calcification） of the aneurysms sac, the size of the aneurysm sac, the aneurysm sac thrombosis, calcification and perforation vessels on aneurysm sac. Results 48 aneurysms were treated with clipping surgery and 91 aneurysms were treated with reconstruction clipping. 8 giant aneurysms were treated with aneurysms trapping or proximal artery clipping. At the same time, superficial temporal artery to middle cerebral artery bypass were completed. There were no significant differences in the complication and prognosis of Glasgow between the three methods. The postoperative complications were 10.4%, 14.3% and 12.5%, respectively. The complication rate in patients with reconstructionclipping surgery was higher and the recurrence rate was 3.3%. Conclusion Neurosurgeons should master a variety of surgical techniques, preoperative comprehensive radiographic data detailed analysis. Optimization of surgical program is selected according to the specific circumstances of aneurysm sac. The proper application of different surgical methods of aneurysm clipping is an ideal choice for treating middle cerebral aneurysms.

关 键 词： 脑动脉瘤 大脑中动脉 夹闭手术 血管搭桥