基层医院开展颅内动脉瘤显微外科手术体会

The Experience of Microsurgery of Intracranial Aneurysms in Grass-roots Hospital

目的探讨基层医院如何开展颅内动脉瘤显微外科手术的经验。方法报告近2年对22例高血压性脑出血、17例慢性硬膜下积液病人的侧裂及鞍区显微解剖资料和显微外科手术夹闭的8例颅内动脉瘤病人的临床资料及手术方法。结果通过对高血压性脑出血、慢性硬膜下积液病人的鞍区显微手术实践,基本掌握了侧裂分离技术和鞍区的解剖知识。成功夹闭8例,9个动脉瘤;术中破裂1例。6例恢复正常生活,1例重残,术后死亡1例,术后脑积水1例。结论熟练的侧裂分离技术和鞍区显微解剖知识是基层医院开展颅内动脉瘤手术的基础。正确把握手术时机、精细的显微操作是动脉瘤手术成功的关键。脑积水为最常见的远期并发症,需行脑室腹腔引流术。

Objective To discuss to how develop the experience on the treatment of intracranial aneurysms in the grass-roots hospital. Methods The clinic information of the microanatomy in sellar region, and the separated techniques of sylvian cistern in 22 cases with hypertensive cerebral hemorrhage and 17 cases chronic subdural effusion and the clinic information, surgical procedures and outcome of the clipped intracranial aneurysms within the latest 2 years were reported. Results The knowledge of the microanatomy in sellar region and the separated techniques of sylvian cistern were basically understood by studying microscopically in the cases. The clip was successfully done in 8 cases (9 aneurysms) . The rupture in operation occurred in one case.6 cases have recovered to normal work, one case was severely disabled and one case was died. Postoperative hydro-cephalus was occurred in one case. Conclusion In order to develop the treatment of intracranial aneurysms in the grass-roots hospital, it is essential to understand the knowledge of the microanatomy in sellar region and the separated techniques of sylvian cistern. It is vital for treating successfully intracranial aneurysms to understand correctly operatiove opportunity and operate carefully under the operative microscope. Hydrocephalus was the most frequently complication, V-P shut be carried out one time.