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。

Complications in intracranial aneurysm embolization with controllable coils

Objective　To explore the causes of countermeasures to the accidents in intracranial aneurysm embolization with controllable coils (mechanical detachable spiral， MDS， and/or Guglielmi detachable coil， GDC).　Methods　From March 1995 to July 1999, 120 patients with intracranial aneurysm (125 aneurysms) were embolized with controllable coils. 25 accidents including aneurysm bleeding， thrombosis or occlusion, and coil end protruding to the parent artery of aneurysm，which occurred in 22 patients (23 aneurysms) during treatment were reviewed.　Results　Among the 25 accidents, concomitant and secondary, there were 9 aneurysm ruptures，7 over-embolizations， 7 coil end protrudings to the parent artery，and 2 thromboses. The accidents resulted in 4 deaths (3.33%，4/120)， 2 permanent neurological deficits (1.67%), and 4 transitory neurological deficits (3.33%). The accidents were related to tho embolizing technique，tho pattern of aneurysm and its parent artery，the observation and management during embolization, and the limitation of coils.　Conclusions　 Skilled emboli zing technique，better understanding of aneurysm and its parent artery angioanatomy，correct judgment during treatment and improved embolic material are helpful to reduce the accidents and the their effect.