大脑中动脉动脉瘤破裂伴脑内血肿的早期手术治疗.doc

文章编号: 座机电话号码2 大脑中动脉动脉瘤破裂伴脑内血肿的早期手术治疗 陈志，唐卫华，缪洪平，吴南，朱刚，冯华（第三军医大学西南医院神经外科 全军神经系统疾病微创诊治专科中心 重庆 400038） 提 要: 目的 探讨大脑中动脉动脉瘤破裂合并脑内血肿早期手术的疗效和经验。 方法 回顾性分析近5年9例大脑中动脉动脉瘤破裂合并脑内血肿患者，早期手术行动脉瘤夹闭及血肿清除术。7例患者术前经DSA或（和）三维CT血管造影 3D-CTA 检查证实，2例患者行CT检查直接手术。术中使用微血管多普勒超声辅助显露动脉瘤及检查动脉瘤夹闭前后载瘤动脉血流。结果 9例患者共10个动脉瘤均成功夹闭，3月后随访时GOS 评分恢复良好者4例，中度病残2例，重度病残2例，植物生存1例。结论 大脑中动脉动脉瘤破裂合并脑内血肿患者病情危重，早期手术能有效改善预后，3D-CTA和术中多普勒超声等无创检查措施能为手术提供帮助。 关键词：颅内动脉瘤；大脑中动脉；脑内血肿；显微外科手术 中图法分类号： 文献标识码：A Early surgical treatment of ruptured middle cerebral artery aneurysms associated with intracerebral haematoma CHEN Zhi , TANG Wei-hua , MIAO Hong-pin , Wu Nan , ZHU Gang，FENG Hua Departments of Neurosurgery, Southwest hospital,Third military medical university, 400038 Chongqing ,China Abstract: Objective To sdudy the experiences and efficacy of early surgical treatment of middle cerebral artery MCA aneurysms associated with intracerebral haematoma. Methods 7 patients with ruptured MCA aneurysms associated with intracerebral haematoma, who underwent early surgery including evacuation of the haematoma and aneurysmal clipping, were retrospective reviewed. Preoperative conventional angiography or and three dimentional CT angiography 3D-CTA was performed in 7 cases. The remaining 2 patient underwent urgent surgery after CT scan. Intraoperative doppler sonography was used to assist exposure of the aneurysms and parent vessels before and after aneurysm clipping. Results 10 aneurysms in 9 patients were clipped. GOS at 3 months were good in 4 cases, moderate in 2, severe in 2, and vegetative in 1. Conclusion Acceptable outcome may be achived in patients with ruptured MCA aneurysms associated with intracerebral haematoma after early surgery. 3D-CTA and intraoperative doppler sonography are helpful for surgical treatment. Key words: Intracranial aneurysm; Middle cerebral artery; Intracerebral haematoma; Microsurgery 大脑中动脉动脉瘤破裂合并内血肿是引起患者昏迷、病情急剧加重的重要原因。尽管动脉瘤破裂出血的手术时机仍存在一定争议，但对于合并颅内血肿的患者多认为早期或急诊手术夹闭动脉瘤并清除血肿有助于改善患者预后[1-5]。我科近5年对7例合并脑内血