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51.
52.
目的探讨颈内动脉巨大动脉瘤的特点和手术策略。方法回顾性分析48例颈内动脉大型和巨大型动脉瘤的手术经验。手术均采用翼点人路,床突旁动脉瘤病例预先暴露颈部颈内动脉以备临时阻断。从硬脑膜内磨除前床突、视神经管上壁以及外侧嵴,以显露动脉瘤的近侧角。术中采用逆向抽吸法使动脉瘤塌陷,如动脉瘤内含机化血栓,则在临时阻断后切开瘤体,用CUSA和取瘤镊去除瘤内血栓,再将动脉瘤夹闭并达到视神经减压的目的。术中监测脑电图和体感诱发电位,并采用术中超声多普勒检查动脉血流。结果46例动脉瘤直接夹闭,2例海绵窦段动脉瘤行动脉瘤孤立并分别做颞浅动脉-大脑中动脉和大隐静脉移植颈外动脉-大脑中动脉搭桥手术。43例术后行DSA检查,绝大多数动脉瘤夹闭满意。按GOS评分术后良好为41例(85.4%),差为5例,死亡2例。结论充分显露、合理应用临时阻断技术、有效的动脉瘤减压,以及术中应用电生理监测和超声多普勒检查等辅助措施,能够取得动脉瘤的满意夹闭。 相似文献
53.
Suhny Abbara Sanjeeva Kalva Ricardo C. Cury Eric M. Isselbacher 《Journal of Cardiovascular Computed Tomography》2007,1(1):40-54
The clinical presentation of diseases involving the thoracic aorta ranges from a large number of asymptomatic patients with clinically undetectable thoracic aortic aneurysm to patients with symptoms of severe chest pain as a result of acute aortic dissection. Thoracic aortic disease often remains undiagnosed until a life-threatening complication occurs or the disease is discovered serendipitously on imaging studies performed for other purposes. Multidetector row computed tomography (MDCT) imaging of the aorta is used to diagnose various acute and chronic conditions, including aortic aneurysms, aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, traumatic injury, rupture, inflammatory disorders, and congenital malformations. This review illustrates the wide range of MDCT imaging findings of thoracic aortic disease. 相似文献
54.
Kiyoaki Takaba Masaki Aota Hiroyuki Koike Yutaka Konishi 《The Japanese Journal of Thoracic and Cardiovascular Surgery》2004,52(4):194-197
Aneurysm of the innominate artery is uncommon compared with other peripheral aneurysms, and holds the potential for rupture,
embolization, or thrombosis as well as various complications caused by compression to the adjacent structures. The most effective
treatment for this condition is surgical resection, but the earlier reports described high mortality rates. We report the
case of an 83-year-old asymptomatic woman with an aneurysm in the innominate artery, which was successfully resected and repaired
with the use of modern surgical techniques of hypothermic circulatory arrest and selective cerebral perfusion. Aggressive
surgical intervention should be employed despite the fact that a patients is asymptomatic. 相似文献
55.
低温体外循环下手术治疗主动窦瘤破裂16例,采用右房切口1例,右室流出道切口11例,窦瘤破入腔和主动脉根部双切口4例。单纯窦瘤破口修补2例;双头垫片针窦瘤基部与空间隔踬同并列间断褥式缝合修补3例; 相似文献
56.
T. Sakaki T. Matsuyama T. Yabuno H. Hashimoto Sh Kurokawa Sh Kawaguchi T. Morimoto 《Acta neurochirurgica》1995,133(1-2):17-21
Summary The authors describe an approach through the temporal horn of the lateral ventricle which proved to be useful for clipping of a large dorsal type basilar bifurcation aneurysms. It facilitates the preservation of the perforating arteries behind the aneurysm, because it gives sufficient working space to move the aneurysm dome. Furthermore this approach avoids many of the disadvantages of other approaches, especially the risk of iatrogenic injuries of the Sylvian or Labe's vein. 相似文献
57.
报告37例主动脉窦瘤破裂手术治疗结果。着重介绍手术方法,主张采用主动脉根部和窦瘤破入心腔的双切口,切除、修补窦瘤的同时矫正合并畸形。伴主动脉瓣膜垂致中度关闭不全者,主张行主动脉瓣替换术。术后早期死亡1例,余35例随访6个月-14年,心功能恢复良好。 相似文献
58.
Lower level of serum potassium and higher level of C-reactive protein as an independent risk factor for giant aneurysms in Kawasaki disease 总被引:7,自引:0,他引:7
Giant aneurysms are the most serious issue of patients with Kawasaki disease (KD). To clarify risk factors for these giant aneurysms, we conducted a matched case-control study. Among the patients reported in nationwide surveys, 117 patients with giant aneurysms had an unequivocal new diagnosis and presented at the treatment center within 9 d of illness. We obtained clinical information on admission of about 69 patients (case) from the treatment centers. One control was selected for each case, an age- and sex-matched patient without coronary involvement, reported from the same treatment center at about the same time as the case, and we obtained the same clinical information about controls. Fourteen variables were analysed with a conditional logistic regression model: body temperature, hematocrit, hemoglobin, numbers of leukocyte and platelets, concentrations of serum albumin, globulin, total cholesterol, sodium, potassium and chloride, erythrocyte sedimentation rate, C-reactive protein and alanine aminotransferase activity. After adjustment for age, duration of illness before admission and use of intravenous gamma globulin therapy, C-reactive protein [odds ratio (OR) = 1.142, 95% confidence interval (CI) 1.054-1.237], alanine aminotransferase activity (OR = 1.008, 95% CI 1.002-1.014), serum sodium concentration (OR = 0.877, 95% CI 0.770-0.999) and serum potassium concentration (OR = 0.319, 95% CI 0.124-0.822) were significantly related to the risk for giant aneurysms. Further analyses with these four explanatory variables revealed that C-reactive protein (OR = 1.159, 95% CI 1.022-1.315) and serum potassium concentration (OR = 0.222, 95% CI 0.052-0.948) met the significant level. Thus, the values for serum C-reactive protein and potassium are independent risk factors for the development of the giant aneurysms of Kawasaki disease. 相似文献
59.
60.
Sylvie Destian M.D. Howard Tung M.D. Richard Gray M.D. David R. Hinton M.D. John Day M.D. Takanori Fukushima M.D. 《Surgical neurology》1994,41(6):472-476
Infectious intracavernous carotid artery aneurysms usually present with ophthalmoplegia and/or signs of cavernous sinus thrombosis. We report an unusual case in which a patient with AIDS presented with intractable epistaxis secondary to rupture of a giant infectious intra-cavernous carotid artery aneurysm. Culture of the aneurysm grew mycobacterium avium intracellulare (MAI). The patient was treated successfully by excision of the aneurysm and reconstruction of the internal carotid artery with a saphenous vein interposition graft. 相似文献