血管内栓塞治疗颅内动脉瘤38例临床分析

Intracranial aneurysm treated by endovascular embolism：an clinical analysis of 38 cases

目的 探讨血管内栓塞治疗颅内动脉瘤的时机、技术要点、疗效及并发症的防治.方法 揭阳市人民医院神经外科自2006年2月至2009年1月在数字减影血管造影（DSA）监视下行血管内栓塞治疗颅内动脉瘤患者38例,其中26例（27个动脉瘤）用机械式可脱性弹簧圈（MDS）栓塞,12例（12个动脉瘤）用电解式可脱性弹簧圈（GDC）栓塞,回顾性分析患者的临床资料并评定栓塞疗效.结果成功栓塞38例39个动脉瘤,其中32例（84.2%1为100%栓塞,4例（10.5%）为95%栓塞,2例（5.26%）为90%栓塞;1例宽颈动脉瘤患者栓塞后并发同侧颈内动脉闭塞,3个月后仍遗留偏瘫、失语.2例动脉瘤患者栓塞术中并发破裂出血,经治疗后恢复;随访除1例老年患者因并发肺部感染及消化道出血死亡外,其余37例患者恢复良好.结论 多数颅内动脉瘤患者可以进行有效的血管内栓塞治疗,血管内栓塞是治疗颅内动脉瘤的一种微创、相对安全、有效的治疗方法.

Objective To explore the timing and technical points in treating intracranial aneurysms with endovascular embolization, and analyze its efficacy and the prevention of its complications. Methods Thirty-eight patients with intracranial aneurysm, admitted to our hospital from February 2006 to January 2009, were treated by endovascular embolism with the help of digital subtraction angiography （DSA）. Twenty-six patients （27 aneurysms） were performed embolization with mechanical detachable coils （MDC） and 12 patients （12 aneurysms） were performed embolization with Guglielmi detachable coils （GDC）. Their clinical data and efficacy were analyzed. Results Thirty-eight cases （39 aneurysms） were successfully embolized： 32 cases （84.2%） were fully embolized; 4 cases （10.5%） were 95% embolized and 2 cases （5.26%） were 90% embolized. Internal carotid artery thrombosis was found in 1 with wild-necked aneurysms after embolism and the patient was found hemiplegia and aphasia after 3 months. Bleeding caused by aneurysm rapture occurred in 2 and recovered after treatment. Follow-up showed that 37 patients were successfully recovered except that 1 elderly patient died of lung infection and gastrointestinal bleeding. Conclusion Endovascular embolization, a minimally invasive, safe and effective technique, can effectively treat most patients with intracranial aneurysms.