摘要
目的:探讨颅内动脉瘤诊断方法的选择以及开颅直接手术或采取血管内介入手术的取向等问题。方法: 2004年1月至2006年12月收治190例颅内动脉瘤患者中男63例、女127例,年龄25～79岁、平均44.7岁。诊断:所有病人术前均行颅脑CT检查、MRI检查37例、MRA31例、通过CTA及3D-CTA确诊134例;DSA/3D-DSA确诊142例;治疗:直接手术96例,其中因血管内手术失败而开颅4例;采用血管内介入治疗92例,其中ONYX胶栓塞2例,其余均采用GDC栓塞手术。方法:死亡9例,其中2例再出血、3例死于严重的血管痉挛,肺炎等并发症死亡4例,其余病人均痊愈出院。结论:CT为蛛网膜下腔出血的首诊选择,MRA可作为无出血史病人的检查,但不宜以此直接手术;CTA/3D-CTA在相当病人中可以确定动脉瘤的大小、部位、供血动脉及破裂点,并依此直接手术;DSA尤其3D- DSA对复杂性的动脉瘤的血供情况可清晰提示并指导手术。血管内栓塞治疗和直接开颅夹闭手术各有优点,我们主张急性期脑肿胀病人应首先尝试行急诊介入治疗,但血管痉挛明显的病人应果断早期手术,其中多发性动脉瘤的重点是判断责任动脉瘤。
Objective： To discuss the selection of diagnosis for intracranial aneurysms, and to analyze therapeutic efficacy of microsurgical treatment end endovascular embolization in the treatment of intracranial eneurysms. Method： One hundred end ninety patients suffered from intracrenial eneurysms between January 2004 to December 2006 were reviewed. Of the 190 patients, male： female = 63 ： 127, median age was 44.7 years. All patients were detected by CT scan, 37cases detected by MRI, 31 cases detected by MRA, 134 cases were confirmed by computered tomographic engiography （CTA） or 3D- CTA, 14：2 cases were confirmed by digital subtract anglography （DSA） . Ninety-six patients were underwent microsurgical treatment, 4 of them were failure of endovascular embolization. Ninety- two cases were underwent endovascular therapy, 2 of them were embolized by ONYX, the other were embolized by guglielmi detachable coil （GDC） . Results： Nine patients died, 2 of them died of rehemorrhage, 3 died of severe vasospasm, 4 died of pneumonia and other complications, and the others were cured. Conclusion： CT was the first choice for the subarachniod hemorrhage; MRA could be a choice for the detect of intracranial aneurysm without hemorrhage, but was not suit for the aneurysm clipping. The size, form, relationship with patent arteries, and even the ruptured point of aneurysms can be dearly demonstrated by CTA, and CTA can be used to the operation for intracranial aneurysms directly. DSA, especially 3D - DSA can display the blood supply of the complicated aneurysms dearly, and can guide the treatment for intracranial aneurysms directly. Endovascular therapy and aneurysm dipping seems like complimentary than competitive, patients with acute cerebral edema should try to undergo andovascular therapy, while the patients with severe vasospasrn should be treated with microsurgical operation immediately and resolutely. The ruptured aneurysms in multiple intracranial aneurysm should be identified correctly and treated in early stage.
出处
《福州总医院学报》
2007年第1期15-17,共3页
Journal of Fuzhou General Hospital
