基层医院开展急诊手术治疗前循环颅内动脉瘤(附38例临床分析)

Emergent surgery for anterior circulation intracranial aneurysm in primary level hospital( clinical analysis of 38 cases)

目的研究基层医院开展急诊手术治疗前循环颅内动脉瘤的效果及临床经验。方法回顾性分析38例前循环动脉瘤急诊手术患者的临床资料。结果 38例患者共有41个动脉瘤,其中前交通动脉瘤27个、大脑中动脉瘤8个、颈内后交通动脉瘤5个、脉络膜前动脉瘤1个;38个动脉瘤为破裂动脉瘤,3个为对侧未破裂的动脉瘤。38个破裂动脉瘤均行急诊动脉瘤夹闭术,3个对侧未破裂动脉瘤行择期手术。手术中瘤颈完全显露时破裂者10例,瘤颈未完全显露时破裂者1例;13例患者去骨瓣,25例患者骨瓣复位。28例患者术后恢复正常,无明显后遗症,4例患者有对侧肢体不全瘫痪,4例患者植物生存,2例患者术后死亡。结论只要具备丰富的颅内动脉显微解剖知识,掌握一定的显微手术操作技巧,严格选择合适的病例;基层医院神经外科可以谨慎地开展前循环颅内动脉瘤急诊手术,并取得较好的疗效。

Objective To study the experience of emergent surgery dealing with anterior circulation intracranial aneurysm at primary level hospital. Methods The clinical data of 38 patients with anterior circulation aneurysm underwent emergent operation were analyzed retrospectively. Results Among 38 cases,included 38 ruptured and 3 unruptured aneurysm,27 were anterior cerebral communicating aneurysm（ Acom An）,8 middle cerebral aneurysm（ MCA An）,6 internal carotid arteryposterior communicating artery aneurysm（ Pcom An）,1 anterior choroidal artery aneurysm（ ACho A）.There were 10 cases of mature rupture and 1 case of immature rupture during the process of exposing the aneurysm. Bone flap were removed in 13 cases and put back in 25. 28 patients recovered to normal life with no obvious disability,4 cases with contralateral paralysis and/or other deficit,4 remained in vegetative state and 2 died after operation. Conclusion Having intimate knowledge of the microanatomy about intracranial artery,skillful dissecting technique,selecting appropriate cases are crucial to carry out emergent ruptured anterior circulation intracranial aneurysm surgery in primary level hospital.