颅内动脉瘤破裂合并脑内血肿的诊治体会

Operative treatment of ruptured intracerebral aneurysms accompanied with hematomas

目的总结颅内动脉瘤破裂合并脑内血肿的临床治疗经验。方法回顾性分析焦作市人民医院神经外科一区自2009年5月至2013年9月收治的23例行急诊手术治疗的颅内动脉瘤破裂合并脑内血肿患者的临床资料。17例患者术前行头颅CTA检查，6例患者术前仅行头颅CT检查。23例均于入院24h内行急诊开颅手术，均采用扩大翼点人路，直视下夹闭动脉瘤并清除脑内血肿。结果根据格拉斯哥预后评分（GOS），出院时恢复良好4例，轻残6例，重残8例，死亡5例。术后15例获得随访，平均随访3-3年，均无再出血发生；8例复查CTA，7例完全夹闭，1例瘤颈少许残余。结论CTA为颅内动脉瘤破裂合并脑内血肿的首选检查手段；急诊手术可提高颅内动脉瘤合并脑内血肿患者的生存率，改善预后。

Objective To evaluate the diagnosis and emergency surgical treatment of raptured intracerebral aneurysms （RIAs） accompanied with intracerebral hematomas （ICH）. Methods A retrospective study was performed on the clinical data of 23 patients oflCH following RIAs, admitted to our hospital from May 2009 to September 2013. CTA was performed in 17 patients and cranial CT in 6 before the operation. The emergent operations were performed in all the patients within 24 hours of aneurysm rupture; pterion approach was adopted to clip the arterial aneurysm and clear intracerebral hematoma. Results According to Glasgow outcome scale （GOS） scores, 4 recovered well, 6 were mildly disabled, 8 were severely disabled and 5 died. After follow-up for 3.3 years in 15 patients, no further bleeding occurred. Eight aneurysms were re-checked by CTA, 7 aneurysms were completely clipped and 1 aneurysm had residual neck. Conclusions Preoperative CTA is essential for the correct diagnosis of ICHs due to RIA. The curative effect of the emergent operation can improve the survival rate and prognosis of patients with RIA accompanied with ICH.