本文選題：小腦后下動(dòng)脈　切入點(diǎn)：動(dòng)脈瘤　出處：《浙江大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：背景:小腦后下動(dòng)脈(posterior inferior cerebellar artery,PICA)遠(yuǎn)端動(dòng)脈瘤在顱內(nèi)動(dòng)脈瘤中發(fā)病率很低。目前小腦后下動(dòng)脈遠(yuǎn)端動(dòng)脈瘤治療處理仍存在爭(zhēng)議,缺乏大量的證據(jù)。除開顱動(dòng)脈瘤夾閉術(shù)伴或不伴血管吻合術(shù)外,介入治療也被一些研究證實(shí)同樣較為安全和有效。但對(duì)于介入治療的具體方法,閉塞載瘤動(dòng)脈的安全性等仍需要更進(jìn)一步的探討。目的:通過回顧性分析我院小腦后下動(dòng)脈遠(yuǎn)端破裂動(dòng)脈瘤血管內(nèi)介入治療的患者,分析和對(duì)比閉塞載瘤動(dòng)脈和單純動(dòng)脈瘤栓塞的差別,以及血管內(nèi)治療總體的有效性和安全性,并分析預(yù)后相關(guān)因素。方法:對(duì)2009年7月至2016年2月期間在我院行血管內(nèi)治療的小腦后下動(dòng)脈遠(yuǎn)端破裂動(dòng)脈瘤進(jìn)行回顧性分析。并對(duì)比動(dòng)脈瘤治療的成功率,手術(shù)相關(guān)并發(fā)癥及患者預(yù)后等因素。結(jié)果:本研究共納入2009年7月至2016年2月間在我院首次確診為PICA遠(yuǎn)端動(dòng)脈瘤破裂并行介入栓塞治療的患者36例。單純動(dòng)脈瘤栓塞8例,閉塞載瘤動(dòng)脈28例。女性26(72.22%)例,男性10(27.78%)例。HuntHess分級(jí)中位數(shù)為3級(jí)。新發(fā)影像學(xué)部分小腦梗塞見于12(34.29%)例患者,其中3例患者術(shù)后意識(shí)模糊無明顯改善,余9名未見神經(jīng)功能異常。出院時(shí)21(77.14%)例恢復(fù)良好。術(shù)后一年28(84.85%)名患者恢復(fù)良好。術(shù)后2年及3年時(shí)分別為27(90%)例,20(90.91%)例。單純栓塞動(dòng)脈瘤和閉塞載瘤動(dòng)脈的患者群體在mRS、手術(shù)相關(guān)并發(fā)癥等方面無顯著性差異�；颊呷朐簳r(shí)的HuntHess分級(jí)、年齡、急性腦積水與其預(yù)后有相關(guān)關(guān)系。結(jié)論:除開顱夾閉術(shù)等治療手段外,血管內(nèi)介入治療小腦后下動(dòng)脈遠(yuǎn)端破裂動(dòng)脈瘤有良好效果及較高的成功率。閉塞載瘤動(dòng)脈與單純動(dòng)脈瘤栓塞均可根據(jù)患者具體情況進(jìn)行選擇作為治療手段,雖然閉塞載瘤動(dòng)脈可能導(dǎo)致部分小腦梗塞但不會(huì)對(duì)患者的生活能力造成明顯影響。患者入院的HuntHess分級(jí)、年齡、急性腦積水與患者預(yù)后有相關(guān)關(guān)系。
[Abstract]:Background: the incidence of distal inferior cerebellar aneurysms in posterior inferior cerebellar artery is very low. At present, the treatment of distal posterior inferior cerebellar artery aneurysm is still controversial. In addition to intracranial aneurysm clipping with or without vascular anastomosis, interventional therapy has been proved to be equally safe and effective in some studies. The safety of occluded aneurysm carrier artery should be further discussed. Objective: to analyze the interventional therapy of ruptured distal posterior inferior cerebellar artery in our hospital. To analyze and compare the difference between occlusive and simple aneurysm embolization, and the overall efficacy and safety of endovascular treatment. Methods: the distal ruptured aneurysms of posterior inferior cerebellar artery treated in our hospital from July 2009 to February 2016 were analyzed retrospectively. Results: from July 2009 to February 2016, 36 patients with ruptured distal aneurysm of PICA and interventional embolization were included in this study. The median of HuntHess grade was 3. The new imaging part of cerebellar infarction was seen in 1234.29) patients, 3 of them had no obvious improvement in consciousness after operation. The remaining 9 patients had no abnormal neurological function. At discharge 2177.14) patients recovered well. One year after operation, 2884.85) patients recovered well. At 2 and 3 years after operation, there were 2790 patients and 2090.91patients, respectively. The group of patients who simply embolized aneurysms and occluded aneurysms was a group of patients. There was no significant difference in MRS, operation-related complications, etc. The HuntHess grade at admission, Age, acute hydrocephalus were correlated with prognosis. Conclusion: in addition to craniotomy and other treatment methods, Endovascular interventional treatment of ruptured aneurysms at the distal end of the posterior inferior cerebellar artery has a good effect and a high success rate. The occlusive aneurysm carrier artery and the simple aneurysm embolization can be selected as the treatment methods according to the specific conditions of the patients. Although the occluded aneurysm may lead to part of cerebellar infarction, it does not have a significant effect on the patients' living ability. The HuntHess grade, age, and acute hydrocephalus are correlated with the prognosis of the patients.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.12

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王中,周岱,崔崗,張世明,朱風(fēng)清;小腦后下動(dòng)脈瘤5例報(bào)告[J];中國神經(jīng)精神疾病雜志;2001年05期

2 李海燕;以頭痛為首發(fā)癥狀的小腦后下動(dòng)脈梗死[J];卒中與神經(jīng)疾病;2003年01期

3 劉浩;中西醫(yī)結(jié)合治療小腦后下動(dòng)脈閉塞綜合征38例[J];中國民間療法;2004年11期

4 梁延海;;20例小腦后下動(dòng)脈瘤的手術(shù)治療[J];內(nèi)蒙古中醫(yī)藥;2011年04期

5 李云輝;梁瑞奇;;末稍性小腦后下動(dòng)脈瘤[J];國外醫(yī)學(xué).神經(jīng)病學(xué)神經(jīng)外科學(xué)分冊(cè);1992年05期

6 金曉,李維平,王天華,陳耕野;小腦后下動(dòng)脈瘤外科治療三例[J];中華神經(jīng)外科雜志;1998年02期

7 金曉,王天華,徐建林,王堅(jiān);小腦后下動(dòng)脈瘤的診治體會(huì)[J];浙江醫(yī)學(xué);1998年02期

8 劉翠芬,王艷敏,呂彤;小腦后下動(dòng)脈閉塞4例臨床分析[J];遼寧醫(yī)學(xué)雜志;1999年04期

9 王國良;38例小腦后下動(dòng)脈瘤手術(shù)治療效果[J];國外醫(yī)學(xué)(腦血管疾病分冊(cè));1999年05期

10 孫淑文;方曉梅;李玉新;;外傷后小腦后下動(dòng)脈區(qū)梗死的治療體會(huì)[J];中國醫(yī)藥指南;2013年36期

相關(guān)會(huì)議論文 前8條

1 朱曉江;邵良;陳志剛;趙三虎;武志堅(jiān);印健;蔣寅;方俊;童文捷;;小腦后下動(dòng)脈起始段夾閉三例報(bào)告[A];中國醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第四屆全國代表大會(huì)論文匯編[C];2009年

2 張世明;徐峰;王中;周幽心;崔崗;李向東;周岱;;小腦后下動(dòng)脈瘤的手術(shù)治療[A];中國醫(yī)師協(xié)會(huì)神經(jīng)外科醫(yī)師分會(huì)第四屆全國代表大會(huì)論文匯編[C];2009年

3 丁義斌;吳春發(fā);郭金城;;延髓背外側(cè)綜合征12例誤診分析[A];江西省第八次中西醫(yī)結(jié)合危重病、急救醫(yī)學(xué)學(xué)術(shù)研討會(huì)論文集[C];2013年

4 劉智良;徐如祥;戴宜武;羅永春;盧洪流;秦家振;李運(yùn)軍;魏群;;載瘤動(dòng)脈閉塞治療小腦后下動(dòng)脈遠(yuǎn)端椎動(dòng)脈動(dòng)脈瘤2例報(bào)告并文獻(xiàn)復(fù)習(xí)[A];中華醫(yī)學(xué)會(huì)神經(jīng)外科學(xué)分會(huì)第九次學(xué)術(shù)會(huì)議論文匯編[C];2010年

5 鄭匡;趙兵;譚顯西;鐘鳴;;載瘤動(dòng)脈近端閉塞技術(shù)在椎動(dòng)脈小腦后下動(dòng)脈段夾層動(dòng)脈瘤中的應(yīng)用[A];2009年浙江省神經(jīng)外科學(xué)術(shù)年會(huì)論文匯編[C];2009年

6 趙兵;鐘鳴;譚顯西;鄭匡;何文根;李連進(jìn);;小腦后下動(dòng)脈動(dòng)脈瘤的分型與栓塞策略[A];2009年浙江省神經(jīng)外科學(xué)術(shù)年會(huì)論文匯編[C];2009年

7 徐子奇;梁輝;羅本燕;潘潔;張?bào)阌?;小腦后下動(dòng)脈粥樣硬化性狹窄累及穿支動(dòng)脈造成延髓梗死1例[A];2012年浙江省神經(jīng)病學(xué)學(xué)術(shù)年會(huì)論文集[C];2012年

8 豐榮;李艷梅;武楠;;1例Wallenberg綜合征患者的護(hù)理[A];全國外科、神經(jīng)內(nèi)外科護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2006年

相關(guān)碩士學(xué)位論文 前3條

1 龔凱;小腦后下動(dòng)脈的顯微解剖和臨床意義[D];天津醫(yī)科大學(xué);2013年

2 陳敬寅;血管內(nèi)介入治療在小腦后下動(dòng)脈動(dòng)脈瘤治療中的應(yīng)用[D];浙江大學(xué);2012年

3 張森林;延髓背外側(cè)綜合征臨床特征及影像學(xué)研究[D];福建醫(yī)科大學(xué);2013年

，

本文編號(hào)：1594748