脑动静脉畸形颅内出血的急诊手术治疗(附96例报告)

Emergent operation on intracranial arteriovenous malformation with intracerebral hemorrhage

目的探讨急诊手术治疗脑动静脉畸形伴颅内出血的临床效果。方法本组急诊手术治疗颅内动静脉畸形伴颅内出血患者96例,其中表现为昏迷、脑疝者60例(62.5%)。术中清除血肿,同时行动静脉畸形全切58例(60.4%);动静脉畸形部分切除12例(12.5%);单纯夹闭畸形血管1例;单纯清除脑内血肿25例(26.0%)。结果术后死亡14例,手术死亡率14.6%。致残率27.1%。结论对动静脉畸形破裂出血,表现昏迷、脑疝的患者行急诊手术治疗是有意义的,且有助于降低总死亡率。

Objective To analyze the clinical effect of emergent operation on intracranial arteriovenous malformation with intracerebral hemorrhage. Methods From April 1982 to August 2004, 96 patients with intracranial arteriovenous malformation and intracranial hematoma were underwent emergent surgery. 60 cases （62.5%） presented coma and tentorial herniation before operation. The hematoma and malformation were totally removed in 58 cases （60.4%）, The malformation were subtotally removed in 12 cases （12.5%）, only the hematoma were evacuated in 25 cases （26.0%）. The abnormal vessles were clipped in l case. Results 14 patients died after operation, The mortality rate was 14.6%. The morbidity of postoperative complication was 27.1%. Conclusions The emergent operation on intracranial arteriovenous malformation with hematoma even in comatose patients with tentorial herniation is useful and possibly reduc the total mortality.