颅内巨大动脉瘤载瘤动脉球囊闭塞及颅内外血管搭桥术

Treatment of Intracranial Giant Aneurysms with Combined Extra-Intracranial Bypass and Balloon Occlusion of Parent Artery

目的探讨颅内巨大动脉瘤的治疗方法及疗效,并对球囊闭塞载瘤动脉近段以及联合颅内外血管搭术治疗方法进行评价。方法对载瘤动脉球囊闭塞术治疗的21例巨大动脉瘤病人的资料进行分析。载瘤动脉闭塞试验(BOT)阳性者,首先行颅内外血管搭桥,再行血管球囊闭塞。结果21例巨大动脉瘤病例中,单用球囊闭塞载瘤动脉17例,联合颅内外搭桥4例。术后随访17例,6个月动脉瘤内血栓形成,2例动脉瘤缩小;2例3年后动脉瘤消失,2例颈内外动脉搭桥术随访3～4年,血管造影示吻合口通畅。结论对直接手术和填塞难以治愈的颅内巨大动脉瘤,载瘤动脉球囊闭塞以及联合颅内外搭桥术是一种有效可取的方法。

Objectives To explore the curative method and effect for intracranial giant aneurysm,and to evaluate extra-intracranial bypass and balloon occlusion of the parent artery treating it.Methods The data of21patients with wide-neck intracranial giant aneurysms,who were treated by combined extra-intracranial bypass and balloon occlusion of parent ateries,were analysed retrospectively.The patients with giant aneurysms in whom the balloon occlusion test was positive were treated first by extra-intracranial bypass,and then by the balloon occlusion of the parent arteries.Results Of21patients with giant aneurysms,17were treated only by balloon occlusion of the parent arteries,and4by the combined extra-intracranial bypass and balloon occlusion of the parent arteries.The data of following up in17patients showed that there were intreanurysmal thrombosis in all the patients and the aneurysms shrank in2cases6months after the operation,and disappeared in2cases3years after the operation.The anastomosed blood vessels was free in2undergoing the extra-intracranial bypass3～4years after the operation.Conclusion The combined extracranial-intracranial bypass and balloon occlusion of the parent artery are an alternative curative method in the patients with aneurysms,which could not be cured only by the conventional interventional or surgical methods.