颅内动脉瘤破裂并脑内血肿的急诊手术治疗

Emergent Microsurgery for Treatment of Ruptured Intracerebral Aneurysms Accompanied with Intracerebral Hematomas

目的探讨颅内动脉瘤破裂并脑内血肿的手术治疗时机和方法,以提高手术疗效。方法回顾性分析2002年4月至2006年10月在我科行急诊手术治疗的32例破裂颅内动脉瘤并脑内血肿患者的临床资料。32例颅内动脉瘤中,大脑中动脉瘤13例,前交通动脉瘤8例,后交通动脉瘤6例,大脑前动脉瘤3例,颈内动脉瘤2例。所有患者术前均行CT检查,28例术前行DSA检查。均在24h内行急诊手术,直视下夹闭动脉瘤并清除血肿。结果按GOS评分,术后恢复良好19例,轻度残废6例,重度残废5例,死亡2例。结论颅内动脉瘤破裂并脑内血肿的急诊手术效果明显,可有效降低病死率,提高恢复等级。

Objective To evaluate the time and method of microsurgery in order to enhance the curative effect on the patients with ruptured intracerebral aneurysms accompanied with intracerebral hematomas. Methods The clinical data of 32 patients with ruptured intracerebral aneurysms accompanied with intracerebral hematomas, who underwent microsurgery in our department from April, 2002 to October, 2006, were analyzed retrospectively. Of the 32 aneurysms, 13 were located in the middle cerebral arteries, 8 in the anterior communicating arteries, 6 in the posterior communicating arteries, 3 in the anterior cerebral arteries and 2 in the internal carotid arteries. CT examination were performed in all the patients and DSA was done in 28 patients before the operation. The emergent operations were performed in all the patients within 24 hours after the aneurysms rupture. Results The aneurysms were clipped and hematomas were evacuated in all the patients. According to GOS, of 32 patients, 19 recovered well, 6 were mildly disabled, 5 were severely disabled and 2 died. Conclusions The emergent microsurgery for evacuation of hematomas and clipping the ~neurysms should be performed in the patient with ruptured intracerebral aneurysms accompanied with intracerebral hematomas. The curative effect of the emergent operation, which can reduce mortality and improve the prognosis, is good in the patients with ruptured intracerebral aneurysms accompanied with intracerebral hematomas.