【摘要】：目的探討經(jīng)翼點入路急診顯微神經(jīng)外科手術(shù)治療破裂大腦中動脈瘤的策略。方法 30例大腦中動脈瘤破裂伴有腦內(nèi)血腫患者,術(shù)前急診行CTA確定動脈瘤的位置、大小,在發(fā)病24 h內(nèi)(入院后6 h內(nèi))控制性降壓下急診經(jīng)翼點入路顯微手術(shù)治療,其中29例行動脈瘤夾閉+血腫清除術(shù),另有1例無法夾閉,只行單純血腫清除,術(shù)后再行動脈瘤栓塞術(shù)。結(jié)果 30例患者手術(shù)順利,腦內(nèi)血腫量為(26.4±7.21)ml;術(shù)后復(fù)查血腫清除滿意,2例出現(xiàn)腦血管痙攣;術(shù)后隨訪6個月至3年,恢復(fù)良好25例,死亡1例,植物生存1例,重殘1例,中殘2例。結(jié)論對于腦內(nèi)血腫量大于30 ml或中線移位大于1 cm的破裂大腦中動脈瘤患者,采用經(jīng)翼點入路顯微手術(shù)清除血腫和夾閉動脈瘤,具有解除腦內(nèi)血腫占位效應(yīng)、防止動脈瘤再次破裂出血、術(shù)后神經(jīng)功能障礙發(fā)生率降低的優(yōu)點。
[Abstract]:Objective to explore the treatment strategy of ruptured middle cerebral artery aneurysm (MCAA) via pterygoid approach. Methods Thirty patients with rupture of middle cerebral artery aneurysm associated with intracerebral hematoma were treated with CTA to determine the location and size of aneurysm before operation. Under controlled hypotension within 24 hours of onset (within 6 hours after admission), emergency microsurgery via pterygoid approach was performed. Among them, 29 cases underwent clipping hematoma removal, the other 1 case could not be clipped, only simple hematoma clearance was performed, and then embolization of aneurysm was performed after operation. Results the operation was successful in 30 patients, the amount of intracerebral hematoma was (26.4 鹵7.21) ml;, the clearance of hematoma was satisfactory, and the cerebral vasospasm occurred in 2 cases. After 6 months to 3 years follow-up, 25 cases recovered well, 1 case died, 1 case survived, 1 case was severely disabled, 2 cases were middle disability. Conclusion for patients with ruptured middle cerebral artery aneurysms whose hematoma volume is more than 30 ml or midline displacement is more than 1 cm, microsurgical removal of hematoma and clipping aneurysm via pterygoid approach has the effect of relieving intracerebral hematoma. The advantage of preventing rerupture of aneurysm and decreasing incidence of neurological dysfunction after operation.
【作者單位】： 安徽醫(yī)科大學(xué)附屬省立醫(yī)院神經(jīng)外科 安徽省腦功能與腦疾病重點實驗室;
【分類號】：R651.1

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