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。

The occasion and the prevention of complications of the false aneurysm after aneurysm ruptured by using GDC endovascular treatment

Objective To summarized occasion and the prevention of complications of the false aneurysm and true aneurysm complex （TAN-FAN） after the aneurysm ruptured by using Guglielmi Detachable Coil （GDC） endovascular embolization. Methods Using the GDC to embolized the sac of 58 patients TAN-FAN. Results In 58 patients of TAN-FAN, 24 cases using the GDC to embolized the sac of TAN-FAN at acute bleeding stage （7 days）, 20 cases was operated at 7 days to 2 weeks, 14 cases was operated at 2 weeks to 1 month. 58 patients of aneurysms were all sucessfully embolized, among them, the true aneurysmal lumen was 100% occluded in 46 cases, 95% occluded in 9 cases, 90% occluded in 3 cases. 13 cases of A type and 31 cases of B type of the false aneurysmal lumen were not embolized by the GDC. In 14 cases of C type of the false aneurysms, 11 cases were only raritas embolized by the GDC, and the other 3 cases were only embolized the true aneurysmal lumen part by the 3D-GDC. There was 1 case complicated with aneurysm rupturing in operation, 2 cases complicated with cerebral vasospasm, and 3 case complicated with cerebral infarction. One recurrent case was cured by secondary-complementary GDC embolizing. According to the Glasgow prognosis score, the therapeutic efficacy was that： 43 cases were in grade Ⅰ, 11 cases were in grade Ⅱ , 3 cases were in grade Ⅲ. One case died, and the morality rate was 1.7%. None of them was re-bleeding with follow-up visiting for 3 to 60 months in post-operation. Conclusion The TAN-FAN complex must embolized early after intracranial aneurysm ruptured. During the endovascular therapy of aneurysms, operator should design individulizationally by patients pathogenetic condition, and use the adaptive embolismic technique. Only had perfect neurosurgical technique, strict normative operation and affluent experience of aneurysmal embolization, should operator utmostly increase the healing rate of aneurysmal embolization and decline the complications.