【摘要】：目的探討介入雜交手術(shù)平臺治療顱內(nèi)復(fù)雜動脈瘤的效果,并觀察數(shù)字減影血管造影技術(shù)(DSA)在手術(shù)治療前后的評估價值。方法采用Solitaire AB支架輔助彈簧圈栓塞治療顱內(nèi)動脈瘤17例(共23個動脈瘤),同時比較2D數(shù)字減影血管造影技術(shù)(2D-DSA)、3D數(shù)字減影血管造影技術(shù)(3D-DSA)在顱內(nèi)動脈瘤檢出率方面的差異。結(jié)果 17例病理證實為顱內(nèi)動脈瘤患者中2D-DSA共檢出16例,1例微小血泡樣寬頸動脈瘤因病灶太小漏診,準(zhǔn)確率為94.12%,3D-DSA全部檢出,準(zhǔn)確率達(dá)100.0%,但兩種檢測方式比較差異無統(tǒng)計學(xué)意義(t=1.030,P=0.310)。15例寬頸動脈瘤術(shù)中達(dá)到致密栓塞;2例未破裂頸內(nèi)動脈巨大寬頸動脈瘤予以較疏松填塞。1例雙側(cè)大腦中動脈寬頸動脈瘤患者因術(shù)前出血量大,栓塞治療后行開顱清除血腫、去骨瓣減壓術(shù)。全組無死亡病例。術(shù)后隨訪3-30個月,16例恢復(fù)工作,1例呈遷延性昏迷狀態(tài)(治療3個月)。復(fù)查DSA16例動脈瘤消失,1例疏松填塞的巨大頸內(nèi)動脈寬頸動脈瘤患者,瘤腔仍有血流灌注,但動脈瘤未增大。結(jié)論支架輔助彈簧圈栓塞技術(shù)能夠有效提氋顱內(nèi)復(fù)雜寬頸動脈瘤栓塞治療的成功率,同時可有效防止再出血,提氋復(fù)雜動脈瘤的治愈率,期間應(yīng)用DSA技術(shù)可確保治療安全性,并對預(yù)后做出可靠判斷。
[Abstract]:Objective to evaluate the efficacy of interventional hybrid surgery platform in the treatment of complex intracranial aneurysms and to evaluate the value of digital subtraction angiography (DSA) before and after operation. Methods 17 cases (23 aneurysms) of intracranial aneurysms were treated with Solitaire AB stent-assisted coil embolization. The difference of 2D digital subtraction angiography (2D-DSA) and 3D digital subtraction angiography (3D-DSA) in the detection rate of intracranial aneurysms was compared. Results among the 17 patients with intracranial aneurysm confirmed by pathology, 16 cases were detected by 2D-DSA, and 1 case of small bulloid wide carotid aneurysm was misdiagnosed because the lesion was too small, and the accuracy was 94.12% 3D-DSA. The accuracy rate was 100. 0%, but there was no significant difference between the two methods (t1.030% P0. 310). 15 cases of wide carotid aneurysms reached dense embolization during operation. 2 cases of large wide carotid aneurysms without ruptured internal carotid artery were tampered with 1 cases of bilateral middle cerebral artery width. Because of the large amount of bleeding in patients with carotid aneurysms, After embolization, craniotomy was performed to remove hematoma and decompression of bone flap. There were no death cases in the whole group. 16 cases were followed up for 3 to 30 months. 1 case was in a prolonged coma state (3 months). The blood perfusion was found in the aneurysm of the large internal carotid artery, but the aneurysm was not enlarged. Conclusion Stent-assisted coils embolization can effectively improve the success rate of embolization of intracranial complex wide-necked aneurysms, prevent rebleeding, and improve the cure rate of complex aneurysms. During the treatment, the DSA technique can ensure the safety of the treatment. The prognosis was judged reliably.
【作者單位】： 湖北省咸寧市中心醫(yī)院(同濟(jì)咸寧醫(yī)院/湖北科技學(xué)院第一臨床學(xué)院)放射科;
【基金】：咸寧市科學(xué)技術(shù)研究與開發(fā)項目,項目編號:咸科技字(2015)-4
【分類號】：R743;R816.1

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