【摘要】：目的:為提高大腦中動脈動脈瘤(MCAA)的診斷和治療水平,總結(jié)155例MCAA的臨床資料,分析其治療方法,探討預(yù)后相關(guān)因素,并結(jié)合尸頭標(biāo)本進(jìn)行大腦中動脈(MCA)的顯微解剖研究,為臨床工作提供參考。 方法:一、回顧性分析1996～2005年間收治的MCAA155例,總結(jié)臨床表現(xiàn)、影像學(xué)資料、治療和術(shù)后并發(fā)癥等情況,并探討MCAA開顱手術(shù)治療的預(yù)后影響因素。 二、應(yīng)用手術(shù)顯微鏡對尸頭標(biāo)本進(jìn)行MCA的顯微解剖研究,為臨床工作提供參考。 結(jié)果:本組資料包括單發(fā)MCAA133例,其中87例行手術(shù)治療,預(yù)后良好54例,預(yù)后差33例,包括5例死亡;46例行栓塞治療,預(yù)后良好39例,預(yù)后差7例,包括1例死亡。對手術(shù)治療的單發(fā)MCAA進(jìn)行預(yù)后相關(guān)因素分析,單因素分析顯示:Hunt-Hess分級、術(shù)前合并顱內(nèi)血腫、手術(shù)時機(jī)、年齡和術(shù)前出血次數(shù)為有統(tǒng)計學(xué)意義的預(yù)后因素;多因素分析顯示術(shù)前Hunt-Hess分級和年齡同預(yù)后有關(guān),為預(yù)后的獨立危險因素。存在MCAA的多發(fā)動脈瘤(MIA)22例,手術(shù)治療15例,術(shù)后預(yù)后良好11例,預(yù)后不良4例;栓塞治療7例,預(yù)后良好6例,死亡1例。MCA的顯微解剖研究顯示,Ml起始部動脈外徑3.13±0.12mm(2.56～4.22mm);M1段分叉部為單干型5%,雙干型85%,三干型10%;分叉前M1段長度為14.38±1.32 mm(10.28～33.58mm);20條MCA共有豆紋動脈151條,平均每條MCA7.55±2.16條。最大的皮質(zhì)動脈是顳枕動脈。 結(jié)論:MCA是顱內(nèi)動脈瘤的好發(fā)部位之一,手術(shù)治療是治療MCAA的首選方法;對部分MCAA患者,栓塞治療同樣可達(dá)到較好療效,栓塞治療的難點在
[Abstract]:Objective: to improve the diagnosis and treatment of middle cerebral aneurysm (MCAA), to summarize the clinical data of 155 cases of MCAA, to analyze the treatment methods, to explore the prognostic factors, and to study the microanatomy of (MCA) in middle cerebral artery (MCA) combined with cadaveric specimens. To provide reference for clinical work. Methods: first, we retrospectively analyzed the clinical manifestations, imaging data, treatment and postoperative complications of patients with MCAA155 from 1996 to 2005, and discussed the prognostic factors of MCAA craniotomy. Secondly, the MCA microanatomy of cadaveric head specimens was studied by using surgical microscope to provide reference for clinical work. Results: there were 87 cases of single MCAA133 with good prognosis (54 cases) and poor prognosis (33 cases including 5 deaths) while 46 cases had good prognosis (39 cases) and poor prognosis (7 cases including 1 death). The prognostic factors of single MCAA were analyzed. Univariate analysis showed that Hunt-Hess grade, preoperative complicated intracranial hematoma, operative timing, age and times of preoperative hemorrhage were statistically significant prognostic factors. Multivariate analysis showed that preoperative Hunt-Hess grade and age were independent risk factors for prognosis. In 22 cases of multiple aneurysms with MCAA, 15 cases were treated surgically, 11 cases had good prognosis and 4 cases had poor prognosis, 7 cases were treated with embolization, 6 cases had good prognosis. The microanatomical study of MCA showed that the external diameter of the artery in the initial part of Ml was 3.13 鹵0.12mm (2.56~4.22mm), the branching part of M1 segment was 5 in single trunk, 85 in double trunk, 10 in triple trunk, the length of M1 segment before bifurcation was 14.38 鹵1.32 mm (10.28~33.58mm), and there were 151 soybean striated arteries in 20 MCA with an average of MCA7.55 鹵2.16. The largest cortical artery is the temporal occipital artery. Conclusion: MCA is one of the most common sites of intracranial aneurysms, and surgical treatment is the first choice in the treatment of MCAA.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2006
【分類號】：R651.1;R322

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 趙大巍;影響顱內(nèi)動脈瘤破裂伴顱內(nèi)血腫行手術(shù)治療預(yù)后因素的分析[D];河北醫(yī)科大學(xué);2012年

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本文編號：2267007