显微外科与血管内治疗联合处理颅内动脉瘤

随着电解可脱弹簧圈（Ｇｕｇｌｉｅｌｍｉｄｅ－ｔａｃｈａｂｌｅｃｏｉｌｓ,ＧＤＣ）和机械可脱弹簧圈（Ｍａｃｈｎｉｃａｌｄｅｔａｃｈａｂｌｅｃｏｉｌｓｙｓｔｅｍ,ＭＤＳ）的问世,已有文献报道用ＧＤＣ和ＭＤＳ来治疗颅内动脉瘤,完全闭塞率达８０％［１、２］。...     

国产机械可脱式弹簧圈介入治疗的动物试验及临床应用

目的 通过国产机械可脱式弹簧圈（ＭＤＳ）的动物试验及临床初步应用,观察其操作性能及致血凝性。方法 利用中国白兔建立分叉部位动脉瘤模型,２周后进行国产机械可脱式弹簧圈的栓塞。５个动脉瘤共使用弹簧圈２４枚。２￣３周后造影复查,并处死动物,滠出动脉瘤标本进行病理检查。临床应用于１０例患者的栓塞,其中动脉瘤７例,外伤性颈内动脉海绵窦瘘（ＣＣＦ）２例,海锦窦区硬脑膜动静脉瘘（ＤＡＶＦ）１例。共使用弹簧圈１４     

脑动脉瘤和脑血管畸形微导管栓塞术的麻醉探讨

脑动脉瘤和脑血管畸形微导管栓塞术的麻醉探讨孔庆仕微导管（Ｍａｇｉｃ－ＢＤ２Ｌ）栓塞术使脑动脉瘤、脑血管畸形患者无需开颅而得到治疗目的。本文应用神经安定镇痛麻醉（ＮＬＡ）和ＳＮＰ控制性降压行微导管栓塞术８例取得满意效果。现将麻醉方法进行总结和探讨。临床...     

铂金丝弹簧圈栓塞颅内动脉瘤手术的麻醉处理

铂金丝弹簧圈（GDC）的问世以来．血管内栓塞治疗由于疗效可靠．微侵袭．逐渐成为颅内动脉瘤血管内治疗的首选方法之一。本院自1998年至2005年5月．对19例对颅内动脉瘤进行了铂金丝弹簧圈栓塞。现将麻醉处理情况报告如下。     

水解微弹簧圈栓塞治疗颅内动脉瘤(附10例报告)

目的 探讨水解微弹簧圈（microplex coilsystem ＆ hydrocoil embolicsystem．MCS ＆ HES）栓塞治疗颅内动脉瘤的疗效。方法 10例颅内动脉瘤患者，均在静脉全麻下股动脉穿刺行全脑血管造影，采用MCS＆HES水解微弹簧圈栓塞治疗。结果 8例患者动脉瘤完全栓塞，90％栓塞2例，其中1例结合Neuroform支架栓塞，1例予球囊辅助。随访1～16个月，部分栓塞的1例复发。结论 水解微弹簧圈栓塞治疗颅内动脉瘤效果确切，手术安全，并发症少，复发率低。     

血管内栓塞治疗中脑动脉瘤破裂

我科 1999年以来共采用电解解脱铂金弹簧圈 (ｇｕｇｌｉｅｌｍｉｄｅｔａｃｈａｂｌｅｃｏｉｌ,ＧＤＣ)血管内栓塞治疗动脉瘤患者 6 8例 ,发生术中破裂 3例 ,报告如下。1.临床资料 :本组男 1例 ,女 2例 ;年龄分别为 4 5、4 0、5 1岁 ,详细资料见表1。2 .讨论 :据文献报道 ,下列因素可能与术中动脉瘤破裂有关 :(1)存在假性动脉瘤 ,造影发现动脉瘤呈葫芦样 ;(2 )曾多次发作ＳＡＨ ;(3)直径 <4ｍｍ的动脉瘤[1] ;(4)填充“最后”1～ 2个ＧＤＣ时 ;(5 )近期曾发生动脉瘤破裂者。尽管血管内栓塞治疗动脉瘤发生破裂的可能性较小 (文献报道为 2 %～4…     

肝动脉栓塞加手术切除治疗大肝癌37例

作者报告３７例大肝癌采用肝动脉栓塞（ＴＡＥ）加手术切除的疗效及临床病理研究结果。３７例肝癌直径５～２４ｃｍ（平均１１．２Ｃｍ）。ＴＡＥ与动脉灌注化疗同时进行。化疗药物括氟尿嘧啶（５－ＦＵ）、阿霉素（ＡＤＭ）或表阿霉素（Ｅ－ＡＤＭ）、丝裂霉素（ＭＭＣ）和顺铂（ＣＤＤＰ）。多采用三种药物联合方案。肝动脉末梢栓塞剂采用国产或进口碘化油，用明胶海绵颗粒作近端栓塞。手术切除前进行１～４次ＴＡＥ，每次相隔４～６周。１７例ＡＦＰ值增高者ＴＡＥ后１０例降至正常水平。肿瘤直径由平均１１．２ｃｍ降至８．５ｃｍ（缩小２６％）。栓塞后手术切除病理标本显示９２％有肿瘤组织坏死，范围达４０％～１００％。１、２、３年生存率分别为８０％、６６．７％和５３．３％。作者认为ＴＡＥ加手术切除是大肝癌的有效治疗方法。     

复方抗癌药物微球栓塞治疗中,晚期肝癌的实验研究与临床应用

目的 研究复方抗癌缓释性药物微球栓塞剂并初步观察临床疗效。方法 采用乙基纤维素包裹氟脲嘧啶，阿霉素（ＡＤＭ）、丝裂霉素（ＭＭＣ），顺铂（ＤＤＰ），４０％碘化油制成微球，ｃｏｍｐｏｕｎｄ ｍｅｄｉｃｉｎｅ ｍｉｃｒｏｓｐｈｅｒｅ（ＣＭＭＳ），测定微球缓释率，临床应用１０例。结论 复方抗癌药物微球，通过栓塞和释放抗癌药物，具有较强的抗癌作用，且副作用小，是较为理想的化学性栓塞剂。     

颅内动脉瘤弹簧圈栓塞治疗术中动脉瘤再破裂的防治

目的颅内动脉瘤在弹簧圈栓塞过程中发生破裂是最可怕的术中并发症之一，本文探讨处理、预防这一并发症的初步经验。方法2002年4月-2006年12月，共有153例患有颅内动脉瘤的患者在我院接受了可脱卸弹簧圈栓塞治疗，其中141例患者曾有过动脉瘤破裂引起蛛网膜下腔出血史。5例有动脉瘤破裂出血史的患者术中再次发生动脉瘤破裂。术中动脉瘤再破裂时，常规使用鱼精蛋白中和肝素，并设法用弹簧圈尽快填塞动脉瘤腔。微导丝引起动脉瘤破裂时，尽量保持微导丝不动，微导管尽快送到瘤腔中进行填塞治疗。若微导管引起破裂而微导管头端位于瘤壁外蛛网膜下腔时，微导管且勿退入瘤腔内，应将弹簧圈经微导管送入蛛网膜下腔一部分后，再将微导管头撤入瘤腔内，继续弹簧圈填塞。若弹簧圈引起破裂，要将弹簧圈完全或部分送出去，将破裂口堵住后，调整微导管头端位置继续弹簧圈填塞。结果在接受动脉瘤栓塞治疗的153例患者中，141例曾有过动脉瘤破裂引起蛛网膜下腔出血，治疗中5例发生了术中再破裂，占动脉瘤破裂引起蛛网膜下腔出血的3．5％，总发生率为3．3％。1例破裂由导丝引起，1例由微导管引起，1例由弹簧圈过度填塞引起，弹簧圈穿孔1例，其余1例由微导管和弹簧圈共同引起。2例死亡，死亡率占术中破裂的40％，占总例数的1．3％；1例患者出院时遗留有右下肢瘫痪，其余2例患者无残留神经系统并发症。结论动脉瘤栓塞术中动脉瘤的再破裂是一少见、威胁生命但又不可避免的事件。应该立即采取妥善措施以挽救患者生命、改善预后、降低可怕并发症的发生。如处理恰当，多数术中动脉瘤破裂的患者能够存活，无后遗症。     

血管内新型液体栓塞剂醋酸纤维素聚合物的研究

目的 研制一种血管内治疗颅内动脉瘤的液体栓塞剂－醋酸纤维素聚合物（ＣＡＰ）。方法 寻找自制ＣＡＰ溶液的最佳配比，以１２只家兔右侧股动脉内动注入此溶液，观察栓塞效果和组织病理变化。结果 ＣＡＰ溶液最佳配比为２５０ｍｇＣＡＰ３ｍｌＤＭＳＯ和８００ｍｇＢｉ２Ｏ３，此溶液易于通过微导管。不产生粘堵，凝固约需５分钟；并且具有组织相容性好，无毒副作用和栓塞血管腔完全牢固持久的优点。结论 ＣＡＰ是一种较理想且有     

颅内动脉瘤囊内栓塞结果影像学判断标准的探讨

目的 探讨颅内动脉瘤囊内栓塞结果的影像学判断标准。方法 ６名专科医师根据动脉瘤栓塞后血管造影不显影为１００％、瘤颈少许残留为９５％、瘤颈残留为９０％、瘤颈残留并有少许瘤体残留为８０％和少部分瘤体残留为〈８０％的栓塞判断标准,对１９９５年３月至１９９９年７月用机械可脱式弹簧圈和（或）电解可脱式弹簧圈囊内栓塞的１２０例（１２１个）动脉瘤的血管造影片进行评价,并分析该标准的合理性、可行性和局限性。结果     

颅内动脉瘤囊内栓塞治疗中并发症的分析

目的 探讨颅内动脉瘤囊内治疗中并发症的发生原因及预防和处理的方法。方法 用可控性弹簧圈栓塞治疗的动脉瘤120例（125个）,其中22例（23个动脉瘤）发生并发症25例次（包括动脉瘤破裂、载瘤动脉血栓形成或其它原因所致的闭塞以及弹簧罪状脱出动脉瘤）,对其发生的原因及预防和治疗方法进行了回顾性分析。结果 22例出现并发症的动脉瘤患者中,动脉瘤破裂出血9例次,过度栓塞7例次,弹簧圈脱出7例次,血栓形成2例次,因并发症而死亡4例（3.33%),永久性神经功能障碍2例（1.67%);一过性神经功能障碍4例（3.33%)。栓塞技术、术中判断和处理的正确与否、动脉瘤和载瘤动脉的特点以及栓塞材料与并发症的发生和结局相关。结论 栓塞技术的提高,动脉瘤和载瘤动脉解剖的深入理解,术中发生情况的正确处理、栓塞材料的改进,有助于降低并发症的发生率改善其预后。     

电解可脱性弹簧圈血管内栓塞颅内动脉瘤的技术及并发症防治

目的总结以电解可脱性弹簧圈(GDC)血管内栓塞治疗颅内动脉瘤的技术要点、并发症及其防治经验。方法采用GDC对168例颅内动脉瘤患者进行动脉瘤囊内栓塞。结果成功栓塞168个动脉瘤,其中100%闭塞的144个,95%闭塞的14个,90%闭塞的10个;全组6例死亡,死亡率3.6%。术中并发动脉瘤破裂3例,脑血管痉挛9例,脑梗死2例,术后弹簧圈末端逸出2例;3例复发者经二次补充GDC栓塞而治愈。随访5~54个月,全组术后均无再出血。结论动脉瘤的血管内治疗应根据病情进行个体化设计,并采用与之相应的栓塞技术才能最大限度的提高动脉瘤栓塞的治愈率、降低并发症。     

Endovascular treatment of basilar tip aneurysms using Guglielmi detachable coils: anatomic and clinical outcomes in 73 patients from a single institution

OBJECTIVE: Seventy-three consecutive patients with 75 basilar tip aneurysms were treated with Guglielmi detachable coil (GDC) technology. Their anatomic and clinical outcomes are discussed. METHODS: Seventy-five basilar tip aneurysms were treated with the GDC system at the University of California, Los Angeles Medical Center from 1990 to 1999. The average age of the population was 48.3 years (range, 28-82 yr). Forty-two patients (57.5%) presented with acute subarachnoid hemorrhage, 8 patients (10.9%) had unruptured aneurysms with mass effect, and 23 patients (31.5%) had incidental aneurysms. Thirty-one aneurysms (41.3%) were small with a small neck, 18 (24%) were small with a wide neck, 16 (21.3%) were large, and 10 (13.3%) were giant aneurysms. RESULTS: Immediate anatomic outcomes demonstrated complete or near-complete occlusion in 64 aneurysms (85.3%) and incomplete occlusion in 7 aneurysms (9.3%). Four aneurysms (5.3%) could not be embolized because of anatomic difficulties. Of the 69 patients treated with GDCs, 63 patients (91.3%) remained neurologically intact or unchanged from their initial clinical status. Procedure-related morbidity and mortality were 4.1% and 1.4%, respectively. Long-term follow-up angiograms were obtained in 41 patients with 42 aneurysms. Thirty aneurysms (71.4%) demonstrated complete or near-complete occlusion. One incompletely embolized giant aneurysm ruptured during the follow-up period. CONCLUSION: In contrast to surgical clipping of basilar tip aneurysms, the main technical challenge of the Guglielmi detachable coiling procedure depends on the shape of the aneurysm, not its location. The results of this study indicate that endovascular GDC technology is an appropriate therapeutic alternative in ruptured or unruptured basilar tip aneurysms regardless of patient age, clinical presentation, clinical status, or timing of treatment.     

脑血管造影三维重建成像在脑动脉瘤诊断和治疗中的初步应用

目的 总结脑血管造影三维重建成像在脑动脉瘤诊断和治疗中的初步应用经验,以提高诊断水平和治疗效果。方法 对65例确诊或疑诊为脑动脉瘤的病例分别行常规脑血管造影成像（二维影像）和脑血管造影三维重建成像（三维影像）检查,并对其结果进行对比分析。结果 65例患者经上述检查,共检出60例66个动脉瘤,5例造影阴性。60例6个动脉瘤中,囊内栓塞43例46个;行载瘤动脉闭塞3例3个;外科手术10例10个;颅内外动脉搭桥术后闭塞载瘤动脉1例1个;未治疗3例6个。有2个动脉瘤二维影像上未显示,而三维影像上显示;3个动脉瘤通过二维影像认为不适合栓塞十分困难或危险,通过三维影像的帮助得以栓塞;3个动脉瘤二维影像上显示可行栓塞,而三维影像发现不能栓塞。囊内栓塞的46个动脉瘤中,38个（82.6%)二维影像上达100%栓塞,但其中8个三维影像上有残留。结论 脑血管造影三维重建成像可提高颅内动脉瘤诊断的准确性和治疗的安全性。     

颅内动脉瘤破裂出血后假性动脉瘤的血管内治疗时机与并发症防治

目的探讨颅内动脉瘤破裂出血后在其破口周围所形成的假性动脉瘤与真性动脉瘤（TAN-FAN）复合体的血管内栓塞时机及并发症防治方法。方法采用电解可脱性弹簧圈对58例TAN—FAN复合体进行血管内栓塞。结果58例TAN—FAN复合体中24例（41．4％）为出血后7天内进行栓塞，20例（34．5％）为出血后7天～2周内进行栓塞，14例（24．1％）为出血后2周～1个月内进行栓塞。58个动脉瘤均被成功栓塞，其中真性动脉瘤腔100％闭塞者46个，95％闭塞者9个，90％闭塞者3个；13例A型与31例B型假性动脉瘤腔均未行弹簧圈填塞，14例C型中11例仅用弹簧圈疏松填塞假性动脉瘤腔，另3例用3D-GDC仅栓塞真性动脉瘤腔部分。术中并发动脉瘤破裂1例；并发脑血管痉挛2例；并发脑梗死3例。1例复发者经二次补充GDC栓塞而治愈。其治疗结果根据Glasgow预后评分：Ⅰ级43例，Ⅱ级11例，Ⅲ级3例，全组死亡1例，死亡率1．7％。术后随访3～60个月均无再出血。结论对动脉瘤破裂后形成的TAN—FAN复合体应早期进行血管内栓塞；只有根据TAN—FAN复合体不同的类型采用不同的栓塞方法进行个体化治疗，并具有丰富的动脉瘤栓塞经验，才能最大限度的降低并发症。     

动脉瘤性蛛网膜下腔出血的早期诊断及治疗

目的探讨动脉瘤性蛛网膜下腔出血（SAH）的早期诊断方法及治疗原则,并客观评价其治疗效果。方法对SAH患者采用影像学检查,结合病史、临床表现进行早期病因诊断;并对96例动脉瘤早期采用电解可脱性弹簧圈进行囊内栓塞;术后早期对症治疗。结果96个动脉瘤均被早期诊断并成功栓塞,其中100％闭塞者83个,95％闭塞者8个,90％闭塞者5个。术中并发动脉瘤破裂3例;并发脑血管痉挛5例;术后1例弹簧圈末端逸出;3例复发者均经二次补充电解可脱性弹圈（GDC）栓塞治愈。全组出现与栓塞技术相关的并发症9例;与SAH有关的永久性后遗症13例（13．5％）。Glasgow预后评分：Ⅰ级77例、Ⅱ级7例、Ⅲ级6例、Ⅳ级3例、Ⅴ级3例,死亡率3．1％。结论对破裂的动脉瘤性SAH进行早期病因学诊断,并采用电解可脱性弹簧圈进行动脉瘤囊内栓塞,术后积极对症治疗是提高动脉瘤性SAH治愈率和降低死亡率、致残率的重要方法。     

Endovascular occlusion of intracranial aneurysms with Guglielmi detachable coils: correlation between coil packing density and coil compaction

Summary  This retrospective analysis was undertaken to evaluate a possible relationship between coil packing densitiy and coil compaction on intracranial aneurysms embolized using Guglielmi detachable coils (GDCs).  Of the patients who underwent endovascular surgery using GDC in our hospital between 1994 and 1998, 33 patients had endovascular treatment with GDC and were examined by follow-up angiography at least 12 months after surgery. They had coil embolization to the extent where aneurysms were no longer filled or only faintly filled as shown by cerebral angiography immediately after surgery.  At follow-up angiography, coil compaction was observed in 3 aneurysms. In all patients with coil compaction, the coil packing density was below 20% (14.5±4.0%). On the other hand, it was over 20% (25.7±4.7%) in all patients without coil compaction. In the 11 patients with a basilar bifurcation aneurysm, the coil packing density was over 24% and no coil compaction was observed.  The coil packing density seems to be one of the critical factors, particularly for predicting whether or not coil compaction will occur. Endovascular surgery should be performed to obtain coil packing density higher than 20%.     

Review of endovascular stent‐assisted embolization for management of intracranial aneurysms

Objective: This was a retrospective review of the results using stent‐assisted coil embolization for management of intracranial aneurysms. Methods: The records of seven patients treated with stent‐assisted Gugliemi detachable coil (GDC) embolization were retrieved from the authors’ prospectively maintained database. The clinical presentation, site and type of aneurysms, treatment procedure and complications, and outcome of these identified cases were reviewed. Results: Between January 2002 and May 2004, seven patients with intracranial aneurysms, four of which were ruptured, were treated by stent‐assisted GDC embolization. Four aneurysms were located at the anterior circulation and three were at the posterior circulation. The indications for stent use were: giant aneurysm (>2.5 cm), dissecting pseudo‐aneurysm, broad‐necked aneurysm and the need for preservation of important parent arteries or branches. Concerning the technical aspect, all except one had successful stent deployment. One stent dislodged after apparent successful deployment. GDC embolization was continued and the aneurysm was partially occluded. More than 90% occlusion of aneurysm sac was achieved in six aneurysms. Intraoperative complications included over‐coagulation, failure in stent deployment, displacement of stent, coil entrapment and thromboembolism. One patient had added focal neurological deficit after the procedure, and one became vegetative due to an unrelated cause. The patient in whom the stent was dislodged suffered another subarachnoid haemorrhage 4 months later and died. Conclusion: Percutaneous intracranial stent is a new and useful device to assist embolization of cerebral aneurysms that were previously not amenable to endovascular therapy. These preliminary results suggest that this procedure could achieve satisfactory outcomes without significant complications.