颅内外血管搭桥联合动脉瘤孤立术治疗大脑中动脉瘤

Intracranial aneurysm isolation combined with extra-intracranial bypass in treatment of middle cerebral artery aneurysm

目的探讨颅内外血管搭桥联合动脉瘤孤立术治疗大脑中动脉瘤的效果。方法选取2013年1月至2015年3月本院收治32例大脑中动脉复杂动脉瘤患者,均实施颅内外血管搭桥联合动脉瘤孤立术,回顾性分析患者术后临床症状及影像学复查恢复情况,对所有患者治疗前后大脑中动脉血流动力学指标进行统计。结果 25例患者术后临床症状显著缓解,mRS评分均为0分,7例实施急诊手术,术后1周患侧肢体肌力恢复至2-3级,改良Rankin评分量表（mRS）评分2-3分,实施颅内外血管搭桥联合动脉瘤孤立术后其靶血管均通畅,均未见原动脉瘤显影,未见新发缺血性脑卒中或梗死病灶。手术后收缩期血流速度和舒张期血流速度均快于手术前（P〈0.05）,血流阻力低于手术前（P〈0.05）。结论大脑中动脉复杂动脉瘤患者实施颅内外血管搭桥联合动脉瘤孤立术能有效改善临床症状,血管通畅率高,效果可靠。

Objective To investigate the effect of intracranial aneurysm isolation combined with extra-intracranial bypass in treatment of middle cerebral artery aneurysm. Methods From January 2013 to March 2015,there were 32 patients with complex middle cerebral artery aneurysm in our hospital,who were treated by intracranial aneurysm isolation combined with extra-intracranial bypass. The clinical symptoms and image examination after surgery were retrospectively analyzed,and the hemodynamic index of middle cerebral artery before and after treatment was statistically analyzed. Results The postoperative clinical symptoms of 25 patients were relieved,the mRS score was 0 point. Seven patients received surgery,1 week later,the muscle force of involved side was grade 2 to 3,the mRS score was 2 to 3 point,the blood flowing smoothly in target vessel,with no original aneurysm,no new ischemic stroke or infarct. After intervention,systolic and diastolic blood flow velocity were faster than those before the intervention（ P〈0. 05）,blood flow resistance were lower than those before intervention（ P〈0. 05）.Conclusion The intracranial aneurysm isolation combined with extra-intracranial bypass can effectively improve the clinical symptoms of patients with complex intracranial aneurysms,with high graft patency rate and reliable effect.