颅内巨大动脉瘤血管内载瘤动脉闭塞治疗的临床研究

目的探讨可脱性球囊闭塞载瘤动脉治疗颅内巨大动脉瘤的技术要点与并发症的防治。方法对32例颅内巨大动脉瘤采用可脱性球囊行载瘤动脉闭塞术．其中29例第1枚球囊同时闭塞了动脉瘤口。栓塞效果根据术中DSA的影像表现分为优、良、中和差4级。术后影像随访采取DSA与，^99Tc^m-ECD SPECT脑血流灌注显像。计数资料采用χ^2检验。结果疗效优26例，良6例；术后死亡1例，病死率0．3％。全组术中并发脑缺血和脑梗死5例，及时发现经处理后恢复正常，术后并发脑缺血和脑梗死6例。术中及术后均无动脉瘤破裂出血。^99Tc^m-ECD SPECT脑血流灌注显像对载瘤动脉闭塞术后脑缺血诊断的灵敏度和准确性明显高于DSA，两者比较均具有显著性差异（P〈0．05）。结论可脱性球囊闭塞载瘤动脉治疗颅内巨大动脉瘤安全可靠，但该疗法有可能导致脑缺血及其他并发症．应严格掌握适应证：^99Tc^m-ECD SPECT脑血流灌注显像在术后随访中具有重要的应用价值。

Clinical research of parent artery occlusion for giant intracranial aneurysms

Objective To explore the technical notes on parent artery occlusion for giant intracranial aneurysms with detachable balloon and prevention of complications. Methods Thirty-two patients with intracranial giant aneurysms received parent artery occlusion with detachable balloon, and 29 of them obtained occlusion of aneurysm neck simultaneously with the first detachable balloon. The embolization effect was rated as four grades （excellent, good, effective and fail） according to the DSA imaging appearance in the operation. DSA and ^99Tc^m-ECD SPECT brain blood perfusion imaging were taken in the follow up after embolization. Numeration data were analyzed by chi-square test. Results In the 32 patients, 26 obtained, excellent embolization effect, 6 good effects and 1 death. The death rate is 0.3%. Five patients suffered complications of cerebral ischemia and cerebral infarction in operation, which were discovered in time and recovered after treatment, and 6 developed cerebral ischemia and cerebral infarction. There was no-occurrence of aneurysm rapture during and after the operation. ^99Tc^m-ECD SPECT was better than DSA in sensitivity and accuracy of diagnOsing cerebral ischemia after embolization. There were significant differences between ^99Tc^m-ECD SPECT and DSA in sensitivity and accuracy （P 〈 0.05）. Conclusion Embolizing the parent artery with detachable balloon to treat intracranial giant aneurysms is safe and reliable, but it also could cause cerebral ischemia and other complications, so the indication should be well controlled. In follow-up after operation, ^99Tc^m-ECD SPECT brain blood perfusion imaging is of significant value.