术中脑血管造影辅助下原位松夹技术在脑动脉瘤夹闭术中的应用

Clinical application of intraoperative digital subtraction angiography assisted aneurysm clip in situ releasing technique in intracranial aneurysm clipping surgery

目的探讨原位松夹技术在脑动脉瘤夹闭术中的应用方法、效果及相关经验。方法191例脑动脉瘤患者在复合手术室行开颅动脉瘤夹闭术,采用术中血管造影(DSA)评价动脉瘤夹闭后的效果;对发生载瘤动脉狭窄的患者采用原位松夹技术调整动脉瘤夹的位置。分析首次夹闭后载瘤动脉狭窄程度及发生率、动脉瘤夹调整次数及原位松夹技术的有效率。结果在191例患者229枚动脉瘤中,首次夹闭后动脉瘤残留24枚(10.5%),动脉瘤周围血管闭塞7例(3.1%),载瘤动脉狭窄22例(9.6%)。22例载瘤动脉狭窄患者中,中重度狭窄10例(45.5%),采用原位松夹技术调整32次,平均1.5次/动脉瘤,19例患者狭窄程度得到明显改善,有效率为86.4%。均没有发生相关脑缺血并发症。结论原位松夹技术可以有效处理动脉瘤夹闭后载瘤动脉瘤狭窄,降低术后相关并发症的发生率。

Objective To explore the application,effect and related experience of in situ releasing technique in clipping of cerebral aneurysms.Method 191 patients with cerebral aneurysms were treated with intracranial aneurysm clipping in hybird operating room;The position of aneurysm clips were adjusted by in situ releasing technique in patients with stenosis of parent artery.The degree and incidence of stenosis of the parent artery,the times of aneurysm clip adjustment and the efficiency of in situ clamp releasing were analyzed.Results Of the 229 aneurysms in 191 patients,24(10.5%)remained after the first clipping,7(3.1%)had peripheral vascular occlusion,and 22(9.6%)had parent artery stenosis.Among the 22 patients with aneurysm carrying artery stenosis,10(45.5%)had moderate to severe stenosis.The in situ clamp releasing technique was used to adjust 32 times,with an average of 1.5 times per aneurysm.The stenosis degree of 19 patients was significantly improved,and the effective rate was 86.4%.There were no complications of cerebral ischemia.ConclusionIn situ releasing technique can effectively deal with the stenosis of the parent aneurysm and reduce the incidence of postoperative complications.