颅内动脉瘤外科治疗500例经验

目的 总结手术治疗动脉瘤的经验。方法 回顾性总结外科治疗的500例Ⅰ-Ⅴ级颅内动脉瘤患者的临床资料，包括动脉瘤的分级、手术时机的选择、控制性低血压麻醉、脑保护剂与载瘤动脉暂时阻断结合应用、经颅多普勒超声动态监测、脑血管痉挛治疗、直接手术中动脉瘤处理技术、血管内动脉瘤栓塞。结果 465例Ⅰ-Ⅳ级颅内动脉瘤患者的手术病死率为27%,1990年前手术的210例病死率为3.8%;1990年后手术的255例病死率为1.9%。35例动脉瘤栓塞的患者无死亡。结论 对颅内动脉瘤采取外科综合治疗措施能有效的改善患者的预后。

Intracranial aneurysms: experience in treating 500 patients

Objective　To summarize the experience in improving the surgical results of patients with aneurysms.　Methods　We retrospectively reviewed the data on the treatment of 500 patients in terms of timing of surgery, induced-hypotensive anesthesia, brain protection combined with temporal occlusion of feeding artery of aneurysm, dynamically monitoring of transcranial Doppler ultrasound, anti-vasospasm treatment, techniques of direct surgery and endovascular embolization of aneurysms.　Results　465 patients underwent surgery. Intraoperative rupture was seen in 27 patients (6.2%), postoperative death in 13 (2.7%), hemipalsy in 8(2.2%) and vegitative state in 2 (5.0%). The operative mortality was 3.8%in 210 patients before 1990 and 1.9% in 255 patients after 1990.　Conclusion　The outcome of intracranial aneurysm can be effectively improved by comprehensive measures as shown in our 500 patients.