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杂交手术早期治疗血肿型前循环复杂动脉瘤11例分析
Early hybrid surgery for management of complex anterior circulation aneurysm with hematoma: analysis of 11 cases
- 第三军医大学学报 2019年41卷第16期 页码：1572-1577
- 作者机构：
1.350001 福州, 福建医科大学省立临床学院福建省立医院神经外科
2.510515 广州，南方医科大学南方医院神经外科
3.350122 福州, 福建中医药大学中西医结合学院
- 作者简介：
[ 张文清，E-mail:zhwqys@126.com ZHANG Wenqing, E-mail:zhwqys@126.com
- 基金信息：福建省科技计划重点项目(2016Y0017)
DOI：10.16016/j.1000-5404.201903065
中图分类号： R651.12;R732.21收稿：2019-03-08，
修回：2019-04-21，
纸质出版：2019-08-30
- 稿件说明：
移动端阅览
张文清, 黄绳跃, 冯文峰, 等. 杂交手术早期治疗血肿型前循环复杂动脉瘤11例分析[J]. 第三军医大学学报, 2019,41(16):1572-1577.
Wenqing ZHANG, Shengyue HUANG, Wenfeng FENG, et al. Early hybrid surgery for management of complex anterior circulation aneurysm with hematoma: analysis of 11 cases[J]. Journal of Third Military Medical University, 2019, 41(16): 1572-1577.
张文清, 黄绳跃, 冯文峰, 等. 杂交手术早期治疗血肿型前循环复杂动脉瘤11例分析[J]. 第三军医大学学报, 2019,41(16):1572-1577. DOI： 10.16016/j.1000-5404.201903065.
Wenqing ZHANG, Shengyue HUANG, Wenfeng FENG, et al. Early hybrid surgery for management of complex anterior circulation aneurysm with hematoma: analysis of 11 cases[J]. Journal of Third Military Medical University, 2019, 41(16): 1572-1577. DOI： 10.16016/j.1000-5404.201903065.
摘要
目的
2
探讨应用杂交手术室早期治疗未发生脑疝的血肿型前循环复杂动脉瘤的效果。
方法
2
回顾性分析本院2014年11月至2017年11月采用杂交手术早期治疗11例血肿型前循环复杂动脉瘤的临床资料
采用术中DSA、球囊临时阻断技术辅助及显微手术相结合妥善处理动脉瘤及清除血肿，其中5例采用颞浅动脉(superficial tempora1 artery，STA)-大脑中动脉(middle cerebral artery，MCA)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；6例动脉瘤行塑形夹闭术，术中DSA造影评估动脉瘤夹闭效果。采用改良Rankin量表评分(modified Rankin scale，mRS)评估患者的预后。
结果
2
11例患者在发病后72 h内于杂交手术室完成动脉瘤杂交手术并清除血肿
5例采用STA-MCA搭桥患者手术顺利，术中造影均通畅，一期行动脉瘤孤立术。6例采用动脉瘤塑形夹闭术，术中DSA提示4例需要调整动脉瘤夹，其中3例穿支血管误夹，1例夹闭不全，调整后均夹闭满意。术后并发小灶性脑梗死1例，癫痫1例，余患者术后无新发神经功能障碍。对11例患者术后3~24个月行临床随访，随访期间未见动脉瘤复发或破裂出血，均无新发神经功能障碍。mRS为0分3例(27.3%)，1分6例(54.5%)，3分1例(9.1%)，4分1例(9.1%)。
结论
2
对于难以直接手术夹闭或血管内栓塞治疗的血肿型前循环复杂动脉瘤
应用杂交手术室早期治疗安全且有效。
Abstract
Objective
2
To assess the efficacy of early hybrid surgery for treatment of complex anterior circulation aneurysm with hematoma but without cerebral hernia.
Methods
2
We retrospectively analyzed the clinical data of 11 patients with complex anterior circulation aneurysm with hematomas
who underwent early hybrid surgery in our hospital between November
2014 and November
2017. In all the cases
the aneurysms were managed and the hematomas were removed by a hybrid approach combining intraoperative digital subtraction angiography (DSA)
temporary balloon occlusion and microsurgery. Five of these patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass combined with aneurysm isolation
in which endovascular balloon occlusion was performed for trapping the aneurysms after intraoperative DSA for verifying the patency of the bridge vessel; in 6 cases
intraoperative angiography and temporary balloon occlusion-assisted aneurysm shaping and clipping were performed
and the clipping effect was verified with intraoperative DSA. The outcomes of the patients following the surgeries were evaluated with modified Rankin scale (mRS).
Results
2
In all the 11 cases
emergency microsurgery and hematoma evacuation were completed successfully in the hybrid operation room within 72 h after onset. In the 5 patients receiving STA-MCA bypass
intraoperative angiography verified the patency of the blood vessels and the aneurysms were trapped successfully in the one-stage operation. In the 6 patients treated with aneurysm shaping and clipping
intraoperative DSA showed that the aneurysm clips needed to be adjusted in 4 patients
including 3 with mistaken clipping of the perforator vessels and 1 with incomplete clipping; the clipping effect was satisfactory after adjustment. Focal cerebral infarction occurred in 1 patient and epilepsy in another after the operation
and all the other patients showed no new neurological dysfunction after the operation. The 11 patients were followed up for 3-24 months postoperatively
during which new neurological dysfunctions
relapse or rupture of the aneurysms did not occur. The postoperative mRS score was 0 in 3 cases (27.3%)
1 in 6 cases (54.5%)
3 in 1 case (9.1%) and 4 in 1 case (9.1%).
Conclusion
2
Hybrid operation can be a safe and effective approach to treatment of complex anterior circulation aneurysms with hematomas that can not be managed by direct surgical clipping or endovascular intervention.
关键词
Keywords
references
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