本文關(guān)鍵詞：顱內(nèi)動脈瘤顯微手術(shù)治療的臨床應(yīng)用研究　出處：《青島大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 顱內(nèi)動脈瘤 顯微手術(shù)治療 終板造瘺 對側(cè)動脈瘤 血泡樣動脈瘤

【摘要】：顱內(nèi)動脈瘤是顱內(nèi)動脈管壁的向外異常膨出,是造成自發(fā)性蛛網(wǎng)膜下腔出血(subarachnoid hemorrhage,SAH)的主要原因。隨著手術(shù)顯微鏡和神經(jīng)外科顯微器械,以及治療理念和技術(shù)的不斷改進(jìn),顯微手術(shù)夾閉顱內(nèi)動脈瘤的治療效果得到進(jìn)一步提高。但仍然有一些問題需要提升和解決,如部分患者會發(fā)展為慢性分流依賴性腦積水;一些相對少見的顱內(nèi)動脈瘤,如多發(fā)動脈瘤、血泡樣動脈瘤等的治療效果仍需進(jìn)一步提高等。本研究基于顱內(nèi)動脈瘤顯微手術(shù)治療存在的部分問題,對1996年10月至2015年12月期間行顯微手術(shù)治療的1534例顱內(nèi)動脈瘤病例進(jìn)行回顧性分析,為今后的診療提供依據(jù)和指導(dǎo)。研究分為四部分:一是對1534例顱內(nèi)動脈瘤的診治資料進(jìn)行臨床分析;二是研究術(shù)中終板造瘺+有效腦脊液引流對慢性分流依賴性腦積水的影響;三是分析一側(cè)翼點(diǎn)入路夾閉對側(cè)動脈瘤的優(yōu)勢及技術(shù)可行性;四是探討顯微手術(shù)治療血泡樣動脈瘤的新方法。第一部分1534例顱內(nèi)動脈瘤顯微手術(shù)治療臨床分析目的總結(jié)顯微手術(shù)治療顱內(nèi)動脈瘤的經(jīng)驗(yàn),分析本組病例的性別、年齡分布,動脈瘤大小、位置,臨床表現(xiàn)以及治療效果等,探討顱內(nèi)動脈瘤顯微手術(shù)治療的安全性和有效性。方法收集1996年10月~2015年12月青島大學(xué)附屬醫(yī)院神經(jīng)外科完成的顯微手術(shù)治療的部分顱內(nèi)動脈瘤患者資料。對性別、年齡、Hunt-Hess分級、動脈瘤的大小、部位、手術(shù)并發(fā)癥、出院時評估、以及影像學(xué)和臨床隨訪結(jié)果等進(jìn)行總結(jié)分析。結(jié)果本組患者1534例,其中男性650例(42.4%)、女性884例(57.6%),男性患者平均年齡49.8±10.5歲、女性患者平均年齡52.6±11.6。Hunt-Hess分級:0級75例(4.9%),I級42例(2.7%),II級742例(48.4%),III級493例(32.1%),IV級161例(10.5%),V級21例(1.4%)。1534個責(zé)任動脈瘤中,前交通動脈、后交通動脈及大腦中動脈為動脈瘤高發(fā)部位,分別占36.6%、27.7%及19.7%。發(fā)病后小于3天手術(shù)的患者898例,占58.5%;發(fā)病后3~14天手術(shù)的患者488例,占31.8%;發(fā)病后2周以上手術(shù)的患者148例,占9.6%。1755個動脈瘤中,顯微手術(shù)成功夾閉1698個,肌肉包裹23個,前期或后期栓塞6個,術(shù)中行孤立術(shù)、閉塞頸內(nèi)動脈4個,外院夾閉1個,未夾閉23個。手術(shù)破裂率為16.6%。出院時,按照格拉斯哥結(jié)局評分(GOS),治愈(GOS 5分)1345例(87.7%),生活自理(GOS 4分)98例(6.4%),植物生存(GOS 3~2分)21例(1.4%),死亡(GOS 1分)70例(4.6%)。結(jié)論本組大宗顱內(nèi)動脈瘤病例有其獨(dú)有的特點(diǎn),顯微手術(shù)治療顱內(nèi)動脈瘤是安全有效的治療方法,可以取得良好的預(yù)后效果。第二部分術(shù)中終板造瘺+腦脊液有效引流對慢性分流依賴性腦積水的影響目的導(dǎo)致慢性分流依賴性腦積水的原因很多,各種技術(shù)措施對預(yù)防其發(fā)生的有效性存在爭論,終板造瘺是爭論較為激烈的技術(shù)之一。本部分的目的是研究終板造瘺、腦脊液有效引流對慢性分流依賴性腦積水發(fā)生的影響,探索更為有效的預(yù)防技術(shù)手段。方法回顧性分析本文第一部分中提到的1534例顱內(nèi)動脈瘤患者資料,選取Hunt-Hess分級III~IV級的病例進(jìn)行研究。以常規(guī)引流為第一組;有效腦脊液引流為第二組;終板造瘺+常規(guī)引流為第三組;終板造瘺+有效腦脊液引流為第四組。比較各組的腦脊液引流量、慢性分流依賴性腦積水的發(fā)生率等。所有統(tǒng)計(jì)資料用SPSS16.0統(tǒng)計(jì)軟件進(jìn)行分析。當(dāng)P0.05時差異有統(tǒng)計(jì)學(xué)意義。結(jié)果符合入組條件、各項(xiàng)觀察指標(biāo)資料完整的病例共512例,常規(guī)引流組192例,有效引流組108例,終板造瘺+常規(guī)引流組120例,終板造瘺+有效引流組92例。t檢驗(yàn)分析顯示有效引流量明顯多于常規(guī)引流,差異具有統(tǒng)計(jì)學(xué)意義(t=92.5,P0.001);有效引流時間明顯長于常規(guī)引流,差異具有統(tǒng)計(jì)學(xué)意義(t=39.4,P0.001)。趨勢性卡方檢驗(yàn)顯示從常規(guī)引流組—有效引流組—終板造瘺+常規(guī)引流組—終板造瘺+有效引流組發(fā)生慢性分流依賴性腦積水的可能逐漸降低(趨勢性,p=0.004)。結(jié)論Hunt-Hess分級III~IV級的顱內(nèi)動脈瘤患者,顯微手術(shù)夾閉術(shù)中行終板造瘺,同時行腦脊液有效引流會顯著降低慢性分流依賴性腦積水的發(fā)生率。第三部分一側(cè)翼點(diǎn)入路顯微手術(shù)夾閉對側(cè)動脈瘤的優(yōu)勢和技術(shù)可行性研究目的顱內(nèi)多發(fā)動脈瘤發(fā)生破裂的機(jī)會比單發(fā)動脈瘤高,其自然死亡率亦高。一次手術(shù)經(jīng)一側(cè)翼點(diǎn)入路顯微手術(shù)夾閉雙側(cè)動脈瘤需要較高的技術(shù)要求。本部分的目的是探討一側(cè)翼點(diǎn)入路顯微手術(shù)夾閉對側(cè)動脈瘤的優(yōu)勢和技術(shù)可行性。方法回顧性分析本文第一部分中提到的1534例顱內(nèi)動脈瘤患者資料,選取前循環(huán)多發(fā)動脈瘤的病例進(jìn)行研究。以分期分側(cè)為第一組;一期分側(cè)為第二組;一期一側(cè)為第三組。比較各組的手術(shù)時間、出血量、住院天數(shù)等。同時分析一側(cè)翼點(diǎn)入路顯微手術(shù)夾閉對側(cè)動脈瘤的可及范圍。所有統(tǒng)計(jì)資料用SPSS16.0統(tǒng)計(jì)軟件進(jìn)行分析。當(dāng)p0.05時差異有統(tǒng)計(jì)學(xué)意義。結(jié)果符合入組條件、各項(xiàng)觀察指標(biāo)資料完整的病例149例,其中分期分側(cè)組52例,一期分側(cè)組34例,一期一側(cè)組63例。方差分析結(jié)果顯示三組間手術(shù)時間差異具有統(tǒng)計(jì)學(xué)意義(p0.05),進(jìn)一步兩兩比較結(jié)果顯示手術(shù)時間一期一側(cè)組一期分側(cè)組分期分側(cè)組。三組間出血量差異具有統(tǒng)計(jì)學(xué)意義(p0.05),進(jìn)一步兩兩比較結(jié)果顯示一期一側(cè)組出血量明顯少于分期分側(cè)組及一期分側(cè)組;而分期分側(cè)組與一期分側(cè)組出血量差異無統(tǒng)計(jì)學(xué)意義。三組間住院時間差異具有統(tǒng)計(jì)學(xué)意義(p0.05),進(jìn)一步兩兩比較結(jié)果顯示分期分側(cè)組住院天數(shù)明顯長于一期分側(cè)組及一期一側(cè)組,一期分側(cè)組與一期一側(cè)組住院天數(shù)無統(tǒng)計(jì)學(xué)差異。結(jié)論一期一側(cè)顯微手術(shù)夾閉顱內(nèi)多發(fā)動脈瘤較分期、分側(cè)手術(shù)更加有利于患者,其治療效果良好。一側(cè)翼點(diǎn)入路顯微手術(shù)夾閉對側(cè)動脈瘤雖然技術(shù)要求高,但有較強(qiáng)的可行性,可夾閉對側(cè)眼動脈至大腦中動脈分叉部位的絕大多數(shù)動脈瘤。第四部分血泡樣動脈瘤的顯微手術(shù)治療目的血泡樣動脈瘤是起自頸內(nèi)動脈床突上段前壁或上壁的非分叉部位的血泡樣的罕見動脈瘤。無論采用何種治療手段,其治療效果均欠佳。本部分回顧性分析血泡樣動脈瘤的特點(diǎn)和顯微手術(shù)治療技巧,以期指導(dǎo)未來診治,提高治療效果。方法回顧性分析本文第一部分中提到的1534例顱內(nèi)動脈瘤患者中資料完整的11例血泡樣動脈瘤,分析其臨床表現(xiàn)等特點(diǎn),探討顯微手術(shù)治療技巧,總結(jié)其治療效果。同時觀察離斷血運(yùn)的硬腦膜的病理學(xué)改變。結(jié)果符合納入標(biāo)準(zhǔn)的患者共11例,其中男性4例、占36.4%,女性7例、占63.6%。發(fā)病年齡均為40~59歲年齡段。入院時Hunt-Hess分級:0級0例,I級0例,II級3例(27.3%),III級4例(36.4%),IV級3例(27.3%),V級1例(9.1%)。本組11枚動脈瘤均采用翼點(diǎn)入路顯微手術(shù)治療。直接夾閉1例(9.1%),孤立手術(shù)4例(36.4%),包裹復(fù)合夾閉手術(shù)6例(54.6%),其中棉片纖維包裹1例、自體硬膜包裹5例。術(shù)中夾閉前破裂10個,破裂率90.9%。按照格拉斯哥結(jié)局評分(GOS),治愈5例(45.5%),生活自理4例(36.4%),死亡1例(9.1%)。結(jié)論顯微手術(shù)夾閉血泡樣動脈瘤可以取得良好的效果,自體硬膜輔助顯微手術(shù)夾閉血泡樣動脈瘤需要較高的手術(shù)技巧,該技術(shù)可以提高手術(shù)治療效果。自體硬膜是理想的輔助夾閉血泡樣動脈瘤的材料。
[Abstract]:Intracranial aneurysm is an outward abnormal expansion of the wall of the intracranial artery, which is the main cause of the spontaneous subarachnoid hemorrhage (subarachnoid hemorrhage, SAH). With the continuous improvement of operative microscope and Department of Neurosurgery microapparatus, as well as the concept and technology of treatment, the effect of microsurgical clipping on intracranial aneurysms has been further improved. But there are still some problems need to improve and solve, such as some patients will develop chronic shunt dependent hydrocephalus; some relatively rare intracranial aneurysms, such as multiple aneurysms, Xuepao aneurysm etc. the treatment effect still needs further improvement. Based on some problems in microsurgical treatment of intracranial aneurysms, 1534 cases of intracranial aneurysms treated by microsurgery from October 1996 to December 2015 were retrospectively analyzed to provide evidence and guidance for future diagnosis and treatment. The research is divided into four parts: diagnosis and treatment data of 1534 cases of intracranial aneurysms were retrospectively analyzed; the two is the study of intraoperative endplate colostomy and effective drainage of cerebrospinal fluid on chronic shunt dependent hydrocephalus; the three is the analysis of side pterional clamping the advantages and technical feasibility of contralateral aneurysm; four is the new method of microsurgery treatment of aneurysm of the xuepao. Objective to summarize the clinical analysis of the treatment of microsurgery treatment of intracranial aneurysms of the experience of the first part of the 1534 cases of intracranial aneurysm microsurgery, analysis of sex and age distribution of patients in this group, aneurysm size, location, clinical manifestations and therapeutic effect of intracranial aneurysm, microsurgery is effective and safe in the treatment of. Methods the data of some patients with intracranial aneurysms were collected from the Department of Neurosurgery of the Affiliated Hospital of Qiingdao University, October 1996 ~2015, which was performed in the Department of Neurosurgery, the Affiliated Hospital of Qiingdao University. Gender, age, Hunt-Hess classification, size and location of aneurysms, operative complications, assessment at discharge, and imaging and clinical follow-up results were analyzed. Results there were 1534 patients in this group, including 650 males (42.4%) and 884 females (57.6%). The average age of male patients is 49.8 + 10.5 years, and the average age of female patients is 52.6 + 11.6. Hunt-Hess classification: 0 grade 75 cases (4.9%), class I 42 cases (2.7%), class II 742 cases (48.4%), III class 493 cases (32.1%), IV level 161 cases (10.5%), V grade 21 (1.4%). Of the 1534 responsible aneurysms, anterior communicating artery, posterior communicating artery and middle cerebral artery were high incidence of aneurysms, which accounted for 36.6%, 27.7% and 19.7% respectively. The patients with less than 3 days after the onset of the disease were 898 cases, accounting for 58.5%; 488 patients were operated on 3~14 days after the onset of the disease, accounting for 31.8%; 148 patients with more than 2 weeks after the onset of the disease accounted for 9.6%. In 1755 aneurysms, 1698 microsurgical clips were successfully clipped, 23 muscles were encapsulated, 6 were embolized at the early stage or late stage, 4 were isolated, 4 were internal carotid artery, 1 were external clipping, and 23 were not clipped. The surgical rupture rate was 16.6%. At discharge, according to Glasgow Outcome Scale (GOS), 1345 (87.7%) patients were cured (GOS 5 points), 98 cases (6.4%) were self-care (GOS 4 points), 21 cases (1.4%) had plant survival (GOS 3~2 score), and death (GOS 1 points) 70 cases (4.6%). Conclusion this group of intracranial aneurysms has its unique characteristics. Microsurgical treatment of intracranial aneurysms is a safe and effective treatment method, which can achieve good prognosis. The second part of endplate colostomy + effective drainage on chronic cerebrospinal fluid shunt dependent hydrocephalus to many causes of chronic shunt dependent hydrocephalus, a variety of technical measures for the prevention of the occurrence of effective dispute, endplate colostomy is one of the more intense debate technology. The purpose of this section is to study the effect of endplate stoma and effective drainage of cerebrospinal fluid on the occurrence of chronic shunt dependent hydrocephalus, and explore more effective preventive techniques. Methods the data of 1534 cases of intracranial aneurysms mentioned in the first part of this article were analyzed retrospectively, and the cases of Hunt-Hess grade III~IV grade were selected. The normal drainage was the first group, the effective cerebrospinal fluid drainage was second groups, the end plate fistula + routine drainage was third groups, and the end plate fistulae + effective cerebrospinal fluid drainage was fourth groups. The flow rate of cerebrospinal fluid (CSF) and the incidence of chronic shunt dependent hydrocephalus were compared in each group. All the statistical data were analyzed by SPSS16.0 software. The difference was statistically significant when P0.05. Results a total of 512 cases were eligible for admission and observation data. There were 192 cases in conventional drainage group, 108 cases in effective drainage group, 120 cases in end plate fistulas plus routine drainage group, and 92 cases in end plate fistulas plus effective drainage group. T test analysis showed that effective drainage volume was significantly more than that of conventional drainage, the difference was statistically significant (t=92.5, P0.001), effective drainage time was significantly longer than that of conventional drainage, the difference was statistically significant (t=39.4, P0.001). Trend chi square test showed that the incidence of chronic shunt dependent hydrocephalus may gradually decrease from conventional drainage group to effective drainage group, endplate fistulas plus routine drainage group, endplate fistulas + effective drainage group (trend, p=0.004). Conclusion Hunt-Hess grade III~IV grade intracranial aneurysms, microsurgical clipping, endplate fistulas and cerebrospinal fluid drainage can significantly reduce the incidence of chronic shunt dependent hydrocephalus. The third part side pterional microsurgery clipping rupture to feasibility study advantages and technology of lateral aneurysms intracranial multiple aneurysms opportunities than single aneurysm, the natural mortality rate is also high. An operation through unilateral pterional microsurgery clipping of bilateral aneurysms require higher technical requirements. The purpose of this part is to investigate the side pterional microsurgery clipping the advantage and feasibility of contralateral aneurysm. Methods the data of 1534 cases of intracranial aneurysms mentioned in the first part of this article were analyzed retrospectively, and the cases of anterior circulation multiple aneurysms were selected. The first group was divided by stages; the first stage was divided.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R651.12

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 Deon F Louw ,Wilson T Asfora ,Garnette R Sutherland ,劉暌;動脈瘤夾簡史[J];中國現(xiàn)代神經(jīng)疾病雜志;2005年04期

2 黃榮華,林瑞生,汪偉巍;一次開顱成功夾閉三個動脈瘤[J];中華神經(jīng)外科雜志;2003年04期

3 白景陽,徐英輝,廉治剛,許友松,李偉華;前組循環(huán)動脈瘤微創(chuàng)手術(shù)治療體會[J];中華神經(jīng)外科疾病研究雜志;2005年02期

4 周加浩;方興根;徐善水;;動脈瘤模型的研究現(xiàn)狀[J];國際神經(jīng)病學(xué)神經(jīng)外科學(xué)雜志;2012年05期

5 陳世全;;動脈瘤夾的折斷[J];國外醫(yī)學(xué).神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊;1979年02期

6 陳忠平,黃強(qiáng);犬實(shí)驗(yàn)動脈瘤模型的研制與應(yīng)用[J];蘇州醫(yī)學(xué)院學(xué)報;1999年04期

7 石祥恩;張永力;吳斌;周忠清;孫玉明;劉方軍;錢海;范濤;李志強(qiáng);;后循環(huán)動脈瘤顯微外科手術(shù)治療[J];中國現(xiàn)代神經(jīng)疾病雜志;2012年01期

8 徐新文;王洪生;趙佩林;;一期開顱夾閉顱內(nèi)前后循環(huán)兩處動脈瘤1例[J];中華神經(jīng)外科疾病研究雜志;2012年03期

9 丘永明;眶上“匙孔”入路夾閉幕上動脈瘤:概念與技術(shù)[J];國外醫(yī)學(xué).神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊;1999年03期

10 楊德林,劉相軫,趙維緩;自制動脈瘤夾和優(yōu)質(zhì)進(jìn)口動脈瘤夾機(jī)械性能對比性研究[J];哈爾濱商業(yè)大學(xué)學(xué)報(自然科學(xué)版);2001年04期

相關(guān)會議論文 前10條

1 李奇;蔣宇鋼;陳宏;羅征;;動脈瘤手術(shù)治療的策略與技巧[A];中國醫(yī)師協(xié)會神經(jīng)外科醫(yī)師分會第四屆全國代表大會論文匯編[C];2009年

2 呂著海;;動脈瘤形狀與瘤夾選擇的探討[A];中華醫(yī)學(xué)會神經(jīng)外科學(xué)分會第九次學(xué)術(shù)會議論文匯編[C];2010年

3 吳慧杰;;59例動脈瘤手術(shù)的配合體會[A];全國手術(shù)室護(hù)理學(xué)術(shù)交流暨專題講座會議論文匯編[C];2003年

4 洪濤;;單側(cè)入路夾閉顱內(nèi)雙側(cè)多發(fā)性動脈瘤[A];中國醫(yī)師協(xié)會神經(jīng)外科醫(yī)師分會第二屆全國代表大會論文匯編[C];2007年

5 石祥恩;張永力;周忠清;劉方軍;孫玉明;錢海;;顱內(nèi)梭形和巨長形動脈瘤的外科治療(附21例報告)[A];中國醫(yī)師協(xié)會神經(jīng)外科醫(yī)師分會第六屆全國代表大會論文匯編[C];2011年

6 張世明;;后循環(huán)動脈瘤的手術(shù)治療[A];海峽兩岸神經(jīng)外科學(xué)術(shù)研討會論文匯編[C];2005年

7 劉崢;王守森;王如密;鄭兆聰;洪景芳;荊俊杰;魏梁鋒;高進(jìn)喜;趙琳;李琦;;位于動脈分叉處小型動脈瘤手術(shù)夾閉[A];2011中華醫(yī)學(xué)會神經(jīng)外科學(xué)學(xué)術(shù)會議論文匯編[C];2011年

8 劉崢;王守森;王如密;鄭兆聰;洪景芳;荊俊杰;魏梁鋒;高進(jìn)喜;張小軍;李琦;;頸內(nèi)動脈床突上段“ 血泡 ”樣動脈瘤手術(shù)治療[A];2011中華醫(yī)學(xué)會神經(jīng)外科學(xué)學(xué)術(shù)會議論文匯編[C];2011年

9 趙繼宗;;顱內(nèi)復(fù)雜型動脈瘤外科治療[A];中華醫(yī)學(xué)會神經(jīng)外科學(xué)分會第九次學(xué)術(shù)會議論文匯編[C];2010年

10 周波;游潮;賀民;孫鴻;毛伯鏞;謝曉東;李浩;劉翼;王朝華;;手術(shù)和介入治療后循環(huán)動脈瘤臨床資料報道[A];2011中華醫(yī)學(xué)會神經(jīng)外科學(xué)學(xué)術(shù)會議論文匯編[C];2011年

相關(guān)重要報紙文章 前2條

1 牛斯;治顱動脈瘤效果佳[N];醫(yī)藥經(jīng)濟(jì)報;2002年

2 黃余紅 丁殿春 劉泉;大腦的“保護(hù)神”[N];中國醫(yī)藥報;2006年

相關(guān)博士學(xué)位論文 前8條

1 李環(huán)廷;顱內(nèi)動脈瘤顯微手術(shù)治療的臨床應(yīng)用研究[D];青島大學(xué);2017年

2 席春江;后循環(huán)動脈瘤血管內(nèi)治療及相關(guān)解剖研究[D];首都醫(yī)科大學(xué);2007年

3 阮迪;浙醫(yī)二院256例動脈瘤手術(shù)時機(jī)與預(yù)后分析[D];浙江大學(xué);2013年

4 羅琨祥;顱內(nèi)動脈瘤治療方式選擇及療效影響因素分析—單中心434例病例回顧性分析[D];廣西醫(yī)科大學(xué);2015年

5 李琦;腦血管疾病的血管影像學(xué)研究[D];重慶醫(yī)科大學(xué);2011年

6 李子付;SDF-1α在調(diào)節(jié)內(nèi)皮祖細(xì)胞參與動脈瘤修復(fù)中的作用及其機(jī)制研究[D];第二軍醫(yī)大學(xué);2013年

7 廖旭興;顱內(nèi)多發(fā)動脈瘤發(fā)病機(jī)制、新手術(shù)入路顯微解剖及應(yīng)用研究[D];南方醫(yī)科大學(xué);2010年

8 甄勇;應(yīng)用組織工程材料栓塞動脈瘤的實(shí)驗(yàn)研究[D];吉林大學(xué);2009年

相關(guān)碩士學(xué)位論文 前10條

1 湯偉;X線評估顱內(nèi)動脈瘤介入治療術(shù)后復(fù)發(fā)的臨床研究[D];南方醫(yī)科大學(xué);2016年

2 郝曦;顱內(nèi)前交通動脈動脈瘤傳統(tǒng)手術(shù)治療的臨床預(yù)后相關(guān)因素回顧性分析[D];昆明醫(yī)科大學(xué);2015年

3 郝錚;床突上段血泡樣動脈瘤診斷及手術(shù)治療的臨床分析（附5病例分析）[D];吉林大學(xué);2017年

4 李愛國;術(shù)中微血管多普勒超聲（IMD）在顱內(nèi)動脈瘤夾閉術(shù)中的作用及意義[D];遵義醫(yī)學(xué)院;2012年

5 劉海玉;大腦中動脈分叉處動脈瘤及其不完全夾閉的血流動力學(xué)分析[D];吉林大學(xué);2011年

6 魏瑞理;腦血管成像技術(shù)在動脈瘤診斷中的臨床價值[D];浙江大學(xué);2004年

7 薛哲;CTA在急性蛛網(wǎng)膜下腔出血診斷的可靠性研究及其在術(shù)中術(shù)后的應(yīng)用[D];中國人民解放軍醫(yī)學(xué)院;2012年

8 周明;聯(lián)合術(shù)前CTA、TCD及術(shù)中MVD輔助治療眼動脈瘤（附17例報告）[D];蘇州大學(xué);2013年

9 張義松;305例顱內(nèi)動脈瘤顯微手術(shù)和血管內(nèi)治療[D];吉林大學(xué);2005年

10 尹廣明;256層3D-CTA與3D-DSA診斷顱內(nèi)動脈瘤的對比研究[D];吉林大學(xué);2013年

，

本文編號：1342683