前循环动脉瘤夹闭术中破裂的处理

Microsurgical treatment of the anterior circulation aneurysm ruptured during operation

目的探讨前循环动脉瘤术中破裂的预防、显微手术处理技巧和方法。方法回顾性分析2004年1月至2009年5月132例患者（135个动脉瘤）显微夹闭术中再破裂的7例前循环动脉瘤的处理，其中后交通动脉瘤2例，前交通动脉瘤2例，大脑中动脉瘤2例，颈内动脉分叉部动脉瘤1例。结果7例术中再破裂动脉瘤均被成功夹闭，患者根据GOS评分标准，3例术后恢复良好，2例中残，1例重残，1例死亡。结论颅内动脉瘤的术中再破裂可发生在手术中的任何环节，显微手术技巧和综合处理措施能减少术中破裂，有效地改善患者预后。

Objective To explore the prevention, microsurgieal technique, and comprehensive measures of anterior circulation ruptured second time during operation. Method A retrospective analysis was made among 132 patients（with 135 aneurysms）. Of 7 aneurysms ruptured second time during operation operated on from January 2004 to May 2009. Two posterior communicating artery aneurysms, 2 anterior communicating artery aneurysms,2 middle cerebral artery ancurysms,and I internal carotid artery bifurcation aneurysm were treated. Results 7 ruptured aneurysms during operation were clipped successfully. Outcom was considered according to GOS as good recovery in 3 cases, mild disability in 2 cases, serious disabibity in 1 case, and 1 death. Conclusions Aneurysm ruptured during operation usually occurred in time which were predissection and during dissection of aneurysms and clip application. It seems possible to reduce incidence of intraoperative aneurysmal rupture and improve the prognosis by utilizing microsurgical and comprehensive measures.