动脉瘤蛛网膜下腔出血的介入治疗

Interventional therapy of aneury smal subarachnoid hemorrhages

目的观察颅内动脉瘤致蛛网膜下腔出血的血管内介入治疗的疗效和并发症,探讨介入治疗的选择、时机和方法。方法总结动脉瘤蛛网膜下腔出血患者应用铂金电解可脱微弹簧圈(GDC)血管内介入栓塞治疗的经验,分析介入治疗的手术方法、病例选择、疗效评定、手术时机和并发症的预防及处理,共总结13例。结果术前CT或腰穿脑脊液检查确诊的13例蛛网膜下腔出血患者,经DSA下全脑血管造影证实有动脉瘤后,全麻下行GDC栓塞治疗,成功12例,疗效满意,其中10例随访1-3年无再出血发生,术后患者无明显偏瘫、失语、智能障碍等严重后遗症,患者住院时间大大缩短。介入治疗时机以出血后3天内进行为佳。结论GDC栓塞治疗动脉瘤蛛网膜下腔出血手术风险小,适应证范围广,后遗症少,住院时间短。

Objective To discuss patient selection,time, method and complication of interventional therapy by observing the therapeutic effect of endovascular interventional therapy for aneurysmal subarachnoid hemorrhage. Methods To analyze how to select method, patient and time, evaluate the therapeutic effect, and prevent and treat the complications of interventional therapy by summing up experience in treating 13 patients with aneursmal subarachnoid hemorrhage with Guglielmi detachable coils （GDCs） embolization therapy. Results 13 patients with subarachnoid hemorrhage confirmed by CT scan or examining cerebrospinal fluid after lumbar puncture, and with confirmed aneurysms by digital subtraction angiography （DSA） preoperatively, were treated with Guglielmi detachable coils（GDCs） embolization therapy under general anesthesia. 12 cases successed. The therapeutic effects were satisfied. There were no postoperative serious sequelae such as manifest hemiplegia,aphasia,disturbance of intelligence and so on. No rebleeding developed in 10 cases during a 1 - 3 year follow - up period. Length of patient stay was shortened obviously. The operation should be performed preferentially within three days from hemorrhage. Conclusion Embolization of aneurysms with subarachnoid hemorrhage with GDCs is a method with low risk of operation, many indications, few sequelae and short length of patient stay.