大脑中动脉动脉瘤伴脑内血肿的显微外科治疗

目的探讨大脑中动脉（MCA）动脉瘤伴颅内血肿的临床特征、影像学表现、显微手术技巧及临床疗效。方法回顾分析16例MCA动脉瘤伴颅内血肿显微外科治疗患者的临床资料,按Hunt-Hess分级：Ⅱ级3例,Ⅲ级5例,Ⅳ级7例,Ⅴ级1例。64排螺旋CT血管造影（CTA）确诊,动脉瘤位于MCA主干1例,分叉部15例。16例均行显微手术治疗,对多发动脉瘤采取早期与择期、一期与分期相结合的方法处理动脉瘤,原则是先处理破裂动脉瘤,再处理未破裂动脉瘤。结果动脉瘤夹闭14例,动脉瘤夹闭＋包裹1例,夹闭一侧动脉瘤、另一侧动脉瘤未处理1例。依据Glasgnw预后评分GOS判断：优良9例,轻残3例,重残2例,死亡2例。结论显微外科手术治疗伴颅内血肿的MCA动脉瘤效果显著。充分的术前评估、合适的手术时机和良好的显微外科手术技巧是提高疗效的关键。早期手术清除颅内血肿并夹闭动脉瘤可有效预防致命的再出血、改善预后。     

辛伐他汀治疗大鼠同种异体动脉硬化的研究

目的探讨辛伐他汀对大鼠同种异体动脉硬化的治疗作用。方法雄性Wistar和sD大鼠各30只,分别作为供受体,颈动脉移植后随机分为实验组和对照组,实验组采用辛伐他汀10mg／（kg·d）治疗8周,对照组每天经口灌胃等量的蒸馏水。分别于术后1、4、8周切取移植的颈动脉进行病理检测和计算机图像系统分析。结果实验组在各个时期单核细胞的浸润比对照组明显减少,内皮细胞较完整;对照组随着时间延长内膜渐增厚,管腔渐狭窄,而实验组则无明显变化。结论辛伐他汀有保护内皮功能、抑制炎症反应的作用,并能延缓大鼠同种异体动脉硬化的进程。     

升主动脉替换联合三分支支架血管术中置入治疗急性A型主动脉夹层

目的 总结升主动脉人工血管替换联合三分支支架血管术中置入治疗急性Stanford A型主动脉夹层的初步经验.方法 2008年6月至2009年9月20例急性A型主动脉夹层病人接受了升主动脉人工血管替换和三分支支架血管置入术.体外循环鼻咽温度降至20℃时,停止下半身灌注,经无名动脉近端升主动脉横断切口,将三分支支架血管置入主动脉弓和近端胸降主动脉真腔内,并将其分支支架血管依次置入左锁骨下动脉、左颈总动脉和无名动脉.将主干支架血管的近端与无名动脉近端的升主动脉切口重建后与替换近端升主动脉的人工血管端端吻合.结果 所有病人术中均顺利地置入三分支支架血管,平均体外循环(163.2±19.2)min,主动脉阻断(89.4±10.0)min,低流量选择性脑灌注和下半身缺血(32.7±6.6)min.术后出现短暂性神智障碍1例,急性肾功能衰竭1例.20例均治愈出院.术后3个月电子束CT检查结果示,主干支架血管及分支支架血管通畅、无扭曲;支架血管置入部位夹层假腔闭合;16例远端胸降主动脉夹层假腔闭合.结论 三分支支架血管术中置入是简化急性主动脉夹层者主动脉弓重建、提高手术安全性的一种有效方法.主要适应证为弓内内膜无破口而需主动脉弓重建的急性A型主动脉夹层病人.支架血管大小、分支支架血管间的距离选择和放置过程中避免内膜损伤是术中三分支支架血管成功放置的关键.

Abstract：

Objective To report the primary experience of open placement of triple-branched stent graft for acute Stanford type A aortic dissection. Methods Between June 2008 and September 2009, 20 well-selected patients with acute Stanford type A aortic dissection underwent open placement of triple-branched stent graft for total arch reconstruction. When core cooling to a 20℃ nasophageal temperature, perfusion to the lower body was discontinued and the ascending aorta was transected at the base of the innominate artery. Through a transverse incision, the triple-branched stent graft was inserted into the true lumen of the arch and descending aorta, and each side arm of the stent graft was positioned one by one into the arch branches.The transected stump of the ascending aorta was reconstructed by inner proximal stent-free dacron tube of the main graft and outer teflon felt, and subsequently continuous anastomosis to the 1-branched dacron tube graft was made. Results Open placement of triple-branched stent graft was technically successful in all patients. The mean cardiopulmonary bypass time, aortic cross-clamp time and lower body arrest time were (163.2 ±19.2) min, (89.4 ±10.0) min and (32. 7 ±6. 6)min, respectively. Transient postoperative neurological dysfunction was observed in 1 patient and acute renal failure in 1 patient. All patients were discharged from the hospital. Their computed tomographic scans at 3 months postoperatively showed that all stent grafts were fully opened without distortion. In the vascular stent implantation site the dissected false lumen was eliminated. The false lumen of the descending aorta distal to the stent graft was closed with thrombus in 16 cases. Conclusion Open placement of triple-branched stent graft is a new effective technique for total arch reconstruction in acute type A aortic dissection. Patients have the indications of the extensive primary repair of the thoracic aorta without primary intimal tears in the arch may be the best candidates for this new technique. The size of the stent graft, the distances between two neighboring side arm grafts and the prevention of the intimal trauma during the placement are crucial for successful open placement of triple-branched stent graft.     

显微外科手术治疗颅内多发动脉瘤22例临床分析

目的 探讨颅内多发动脉瘤的显微外科手术时机、方法及影响手术效果的相关因素.方法 回顾分析22例54个颅内多发动脉瘤行显微外科手术治疗的临床资料.采取早期与择期、一期与分期相结合的方法处理多发动脉瘤,原则是先处理破裂动脉瘤,再处理未破裂动脉瘤.结果 22例54个颅内多发动脉瘤直接夹闭48个,包裹3个,未处理3个.依据格拉斯哥结果评分判断预后:优良16例,轻残3例,重残2例,死亡1例.结论 显微外科手术治疗颅内多发动脉瘤效果显著,正确判断责任动脉瘤并予首先处理,根据动脉瘤部位、Hunt-Hess临床分级及患者自身状况等选择一期或分期手术可达到良好治疗效果.     

64排螺旋CT血管造影诊断颅内镜像动脉瘤

目的探讨64排螺旋CT血管造影(CTA)在颅内镜像动脉瘤(IMIA)诊断中的临床应用价值。方法分析经显微外科手术和介入栓塞证实的20例IMIA患者的临床资料。20例IMIA术前均经64排螺旋CTA检查确诊,CTA扫描层厚0.625mm,后处理技术包括多层面重建(MPR)、表面遮盖三维重建(3-SSD)、容积显示重建(VR)、最大密度投影重建(MIP),并对照手术及介入栓塞治疗评估其诊断价值。结果 20例IM-IA患者64排螺旋CTA共发现42个动脉瘤,其中2个动脉瘤19例,4个动脉瘤1例。两侧动脉瘤的位置、大小、形态完全对称(Ⅰ型)7例,不完全对称(Ⅱ型)13例。64排螺旋CTA能清晰显示IMIA的位置、瘤体大小、瘤颈宽度、瘤顶指向、载瘤动脉及动脉瘤与临近血管和骨性组织间的空间关系。结论 64排螺旋CTA诊断颅内镜像动脉瘤具有较高准确性,可作为IMIA诊断的首选无创伤检查方法。将IMIA分为Ⅰ型和Ⅱ型有助于判断出血的责任动脉瘤。     

大脑中动脉镜像动脉瘤

目的 探讨大脑中动脉(MCA)镜像动脉瘤的临床特征、影像学改变及显微外科手术治疗的疗效.方法 回顾分析显微外科手术治疗的9例18个MCA镜像动脉瘤患者的临床资料.采取早期与择期、一期与分期相结合的方法处理MCA镜像动脉瘤,原则是先处理破裂动脉瘤,再处理未破裂动脉瘤.结果 动脉瘤直接夹闭17个,未处理1个.依据GOS判断:优良6例,轻残2例,重残1例.结论 将MCA镜像动脉瘤分为Ⅰ型(完全对称型)和Ⅱ型(不完全对称型)有助于判断出血的责任动脉瘤.显微外科手术治疗MCA镜像动脉瘤效果显著.

Abstract：

Objective To study the clinical characteristics, neuroradiological manifestations of mirror - image aneurysm of middle cerebral artery (MCA) and effects of microsurgical management.Method The clinical data of 9 cases with 18 mirror - image aneurysms of MCA which underwent microsurgical operation were analysed retrospectively. The mirror - image aneurysms of MCA were treated through the method of combining early - stage with select - stage operation and one - stage with two - stage operation. The operating principle was the ruptured aneurysm performed treated first and the unruptureed aneurysm performed treated second. Results Seventeen aneurysms were clipped directly and one aneurysm did not treat. Surgical outcome were good in 6 cases, light disability in 2 cases and severe disability in 1 case. Conclusions It can help to determine the responsibility aneurysm of ruptured aneurysms if the mirror - image aneurysm of MCA had been divided into Ⅰ model ( perfectly symmetry model ) and Ⅱ model ( in perfectly symmetry model). The surgical outcome were predominance if the mirror -image aneurysm of MCA performed microsurgical operation.     

显微手术治疗大脑中动脉分叉部动脉瘤

目的 探讨大脑中动脉(MCA)分叉部动脉瘤的解剖特点、临床特征、影像学表现、显微手术技巧及临床疗效.方法 回顾分析41 例MCA 分叉部动脉瘤显微外科治疗患者的临床资料,39 例有动脉瘤破裂出血的临床表现,按Hunt-Hess 分级:0～Ⅰ级5 例,Ⅱ级15 例,Ⅲ级11 例,Ⅳ级9 例,Ⅴ级1 例.64 排螺旋CT 血管造影(CTA)确诊.41 例均行显微手术治疗,手术入路为翼点入路或扩大翼点入路.对多发动脉瘤采取早期与择期、一期与分期相结合的方法处理动脉瘤,原则是先处理破裂动脉瘤,再处理未破裂动脉瘤.结果 动脉瘤夹闭38 例,动脉瘤夹闭+包裹2 例,夹闭一侧动脉瘤,另一侧动脉瘤未处理1 例.依据GOS 判断:优良31 例,轻残6 例,重残2 例,死亡2 例.结论 显微外科手术治疗MCA 分叉部动脉瘤效果显著.熟悉MCA 分叉部动脉瘤的解剖特征有助于减少术中血管损伤和术后神经功能障碍;对合并脑内血肿的MCA 分叉部动脉瘤,应急诊手术清除血肿并夹闭动脉瘤.     

后交通动脉镜像动脉瘤的影像学特征及手术疗效

目的探讨后交通动脉（PCoA）镜像动脉瘤的影像学特征、手术时机与方法，以及显微外科手术的疗效。方法回顾性分析显微外科手术治疗的8例（16个）PCoA镜像动脉瘤患者的临床资料。采取早期与择期、一期与二期相结合的方法处理PCoA镜像动脉瘤。原则是先处理破裂动脉瘤，再处理未破裂动脉瘤。结果①PCoA镜像动脉瘤均位于颈内动脉一后交通动脉的分叉处，两侧动脉瘤的大小、形态完全对称（Ⅰ型）的有6例，不完全对称（Ⅱ型）的有2例。动脉瘤大小：0．5～1．5cm的有9个，〉1．5—2．0cm的有5个，〉2．0cm的有2个。入院时Hunt—Hess分级Ⅱ级的有2例，Ⅲ级的有4例，Ⅳ级的有2例。②直接夹闭PCoA镜像动脉瘤15个，未处理的有1个。一期手术5例，均经双侧开颅，夹闭PCoA动脉瘤10个，对其中2例同时清除脑内血肿。二期手术2例，第1次手术夹闭一侧PCoA动脉瘤2个，对其中1例同时清除脑内血肿，第2次手术夹闭另一侧PCoA动脉瘤2个。夹闭一侧PCoA动脉瘤后，对侧动脉瘤未处理者1例。③依据格拉斯哥预后评分：良好的有6例，轻残的有1例，重残的有1例。随访3～48个月，动脉瘤无复发。结论显微外科手术治疗PCoA镜像动脉瘤效果显著，将PCoA镜像动脉瘤分为Ⅰ型和Ⅱ型，有助于判断出血的责任动脉瘤；根据动脉瘤的形态、患者Hunt-Hess分级及周身状况等选择一期或二期手术，可达到良好的效果。     

辛伐他汀治疗大鼠同种异体动脉硬化的研究

目的 探讨辛伐他汀对大鼠同种异体动脉硬化的治疗作用.方法 雄性Wistar和SD大鼠各30只,分别作为供受体,颈动脉移植后随机分为实验组和对照组,实验组采用辛伐他汀10 mg/(kg·d)治疗8周,对照组每天经口灌胃等量的蒸馏水.分别于术后1、4、8周切取移植的颈动脉进行病理检测和计算机图像系统分析.结果 实验组在各个时期单核细胞的浸润比对照组明显减少,内皮细胞较完整;对照组随着时间延长内膜渐增厚,管腔渐狭窄,而实验组则无明显变化.结论 辛伐他汀有保护内皮功能、抑制炎症反应的作用,并能延缓大鼠同种异体动脉硬化的进程.