颅内动脉瘤显微夹闭术中临时阻断技术的应用技巧

Application of temporary parent artery occlusion during clipping intracranial aneurysms

目的探讨颅内动脉瘤显微夹闭术中载瘤动脉临时阻断技术所致瘤内相关血流动力学变化规律及其应用技巧。方法回顾性分析2014年1月至2018年12月显微夹闭术治疗的55例(55个)颅内动脉瘤的临床资料,总结术中载瘤动脉临时阻断经验。术后24~48 h头颅CT检查临时阻断区有无新发梗死灶作为判断与临时阻断技术相关联的并发症。结果载瘤动脉临时阻断以近端阻断为主,共48例;近、远端同时阻断共7例。术中载瘤动脉阻断时间2~20 min,平均(6.1±2.3)min。持续阻断共43例,间接阻断12例,间接阻断次数2~3次,间隔3~5 min。术后7例出现新发梗死灶,其中后交通动脉动脉瘤3例,大脑中动脉动脉瘤2例,前交通动脉动脉瘤2例。结论颅内动脉瘤显微夹闭术中载瘤动脉临时阻断可造成动脉瘤内明显的血流动力学变化,术后早期继发性梗死灶与临时阻断技术密切相关。

Objective To investigate the hemodynamic changes in aneurysms caused by temporary parent artery occlusion(TAO) during clipping the intracranial aneurysms and the skills of TAO.Methods The clinical data of 55 patients(55 aneurysms)with intracranial aneurysm who were treated by clipping from January 2014 to December 2018 were retrospectively analyzed,and the experience of TAO during the operation was summarized.The CT examination was used to detect the new cerebral infarction associated with the TAO 24 to 48 hours after the operation.Results The TAO was performed in the proximal segment of parent artery of 48 patients,and the proximal combined with distal of 7 patients.The time of TAO ranged from 2 to 20 minutes,with an average of(6.1±2.3)minutes.Of these 55 patients,43 patients received continuous occlusion and 12 intermittent occlusion(number of occlusion ranging from 2 to 3,interval time ranging from 3 to 5 minutes).New cerebral infarction occurred in 7 patients,including 3 posterior communicating artery aneurysms,2 middle cerebral artery aneurysms and 2 anterior communicating artery aneurysms.Conclusions TAO can cause significant hemodynamic changes in the aneurysms.Early postoperative secondary cerebral infarction is closely related to the TAO.