单侧颈动脉结扎治疗海绵窦段动脉瘤(附15例报告)

Ligation of unilateral carotid artery to treat intracavernous aneurysms: report of 15 cases

目的回顾性分析15例单侧颈动脉结扎治疗海绵窦段动脉瘤患者病历资料,探讨颈动脉结扎的适应证、术前准备、手术方案选择、术后并发症的防治。方法 15例患者均为DSA证实的海绵窦段动脉瘤患者,其中 11例为海绵窦段巨大动脉瘤,4例为创伤性动脉瘤,术前行马它氏试验2周以上,9例为缓慢夹闭颈内动脉再行颈内动脉结扎术,2例行直接结扎颈内动脉,4例行直接结扎颈总动脉。8例术中术后行Doppler监测,全部病例术后行心电、血压等监护。结果 15例患者中,术后2例出现并发症,1例为术后第5周缓慢出现对侧肢体偏瘫,1例为术后 4h出现意识变差,肢体活动障碍,而行急诊手术再次开放颈内动脉,但术后患者仍有偏瘫。结论缓慢夹闭颈内动脉是治疗海绵窦段动脉瘤的一种可行方法。

Objective This paper retrospectively reported 15 patients with intracavernous aneurysms treated with ligation of the carotid artery,and discussed the preoperative preparation.choosing operative regimes and complications of the operation. Methods The 15 patients were confirmed to have cavernous carotid aneurysms by DSA. Among them,11 cases of them are giant intracavernous aneurysms,4 cases of them are traumatic intracavernous aneurysms. 9 cases with gradual occlusion by artery clips and then with ligation of internal carotid artery. 2 case with directly ligation of the internal carotid artery and 4 case ligation the common carotid artery. All patients were underwent Matas test for at least 2 weeks. Partial patients were used transcranial Doppler monitoring. All patients after operation were sent to the ICU under custody. Results 2 patients of the 15 patients had complications （ 13.3%o ） postoperatively. One patient underwent gradual occlusion of the internal carotid artery .the patient developed hemiplegia gradually 5 weeks after operation . Hemiplegia and unconsciousness were present in another patient postoperative 4 hours. Conclusion Synthetic assessment of the patients＇preoperative condition is very important to reduce the postoperative complications, ligation of unilateral carotid artery is a useful way to treat giant intracavernous aneurysms.