本文關(guān)鍵詞： 顱內(nèi)夾層動(dòng)脈瘤 診斷 治療　出處：《吉林大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：目前國(guó)內(nèi)關(guān)于顱內(nèi)夾層動(dòng)脈瘤（Intracranial DissectingAneurysm,IDA）的臨床研究甚少。本研究總結(jié)9例IDA患者的臨床資料及治療經(jīng)驗(yàn),探討其血管內(nèi)治療方案的選擇及療效。 臨床資料和方法：2008年12月至2014年12月間在吉林大學(xué)中日聯(lián)誼醫(yī)院神經(jīng)外一科收治IDA患者9例，男6例,女3例，年齡31~62歲,平均48.9歲，合并高血壓病史2例、肺部感染2例，均無明顯頭頸部外傷史。首發(fā)臨床表現(xiàn)：頭痛7例，意識(shí)不清2例，抽搐2例，頭暈2例，惡心嘔吐4例，言語不清、肢體活動(dòng)不靈等缺血癥狀1例，抽搐、頭暈頭痛、惡心嘔吐等占位性癥狀1例。均經(jīng)DSA或CTA檢查確診。頭部CT檢查，1例頭部CT未見蛛網(wǎng)膜下腔出血，示蝶鞍增大，向右后方突出，可見團(tuán)塊狀高密度影及斑片狀鈣化，局部可見骨質(zhì)破壞。其余8例患者示蛛網(wǎng)膜下腔出血，Hunt-Hess分級(jí)Ⅱ級(jí)6例、Ⅲ級(jí)2例，其中2例為二次破裂。DSA檢查示9例患者均有不同程度的不規(guī)則官腔狹窄，其中1例造影可顯示雙腔征（對(duì)比劑在血管腔與壁內(nèi)血腫內(nèi)同時(shí)顯影）、雙向血流、晚期動(dòng)脈顯像造影劑夾層內(nèi)滯留等夾層動(dòng)脈的直接征象。9例中2例屬于頸內(nèi)動(dòng)脈系IDA，分別采用單支架輔助彈簧圈栓塞術(shù)和球囊閉塞術(shù)。7例屬于椎-基底動(dòng)脈系IDA，其中5例IDA位于PICA起始部遠(yuǎn)端，2例IDA位于PICA起始部處。7例中1例PICA起始部遠(yuǎn)端IDA因經(jīng)濟(jì)原因不接受血管內(nèi)介入手術(shù)，采用開顱夾層動(dòng)脈瘤孤立術(shù)，2例PICA起始部遠(yuǎn)端IDA和1例PICA起始部IDA均采用單純彈簧圈栓塞術(shù)，1例PICA起始部遠(yuǎn)端IDA采用單支架輔助彈簧圈栓塞術(shù)，1例PICA起始部IDA和1例PICA起始部遠(yuǎn)端IDA均采用雙支架輔助彈簧圈栓塞術(shù)。 結(jié)果：9例IDA患者中開顱夾層動(dòng)脈瘤孤立術(shù)1例，單純球囊閉塞術(shù)1例，單純彈簧圈閉塞術(shù)3例，單支架輔助彈簧圈栓塞術(shù)2例，,雙支架輔助彈簧圈栓塞術(shù)2例。隨訪1個(gè)月至6年，平均34.7個(gè)月。9例患者中7例治愈，，1例出現(xiàn)一側(cè)基底節(jié)區(qū)腦梗死，1例死亡。 結(jié)論：IDA早期診斷、早期治療預(yù)后良好。二次破裂的IDA致死率及致殘率極高,臨床預(yù)后極差。DSA檢查是IDA診斷的金標(biāo)準(zhǔn)。IDA血管內(nèi)治療為一個(gè)安全可靠的治療方法。治療方案應(yīng)根據(jù)其臨床癥狀、IDA形態(tài)、發(fā)生部位而確定。根據(jù)病人情況綜合分析行個(gè)體化血管內(nèi)治療很重要。
[Abstract]:Objective: to investigate the intracranial dissecting aneurysm Intracranial DissectingAneurysm in China. This study summarized the clinical data and treatment experience of 9 patients with IDA, and discussed the choice and effect of endovascular treatment. Clinical materials and methods: from December 2008 to December 2014, 9 IDA patients (6 males and 3 females, aged 31 or 62 years) were treated in the Department of Neurology, Sino-Japanese Friendship Hospital, Jilin University. The average age was 48.9 years old. There were 2 cases of hypertension and 2 cases of pulmonary infection. The first clinical manifestations were headache in 7 cases, confusion in 2 cases, convulsion in 2 cases, dizziness in 2 cases. There were 4 cases of nausea and vomiting, 1 case of poor speech, 1 case of ischemic symptoms, 1 case of convulsion, dizziness, headache, nausea and vomiting. All cases were diagnosed by DSA or CTA. There was no subarachnoid hemorrhage on CT in one case, which showed enlargement of the Sella turcica, protruding to the right posterior, mass high density shadow and patchy calcification, local bone destruction, and subarachnoid hemorrhage in the other 8 cases. There were 6 cases of grade 鈪

本文編號(hào)：1485019