颅内动脉瘤术中破裂的防范及处理措施

目的探讨颅内动脉瘤术中破裂出血的防范及处理措施。方法回顾性分析57例颅内动脉瘤行开颅夹闭手术。结果本组术中破裂12例,占总数的21%。其中8例经处理后顺利夹闭;4例术后死于脑疝。结论手术操作失当易增加某些脑动脉瘤早期手术中破裂的机会;动脉瘤破裂后的急性脑肿胀、盲目操作导致的副损伤是影响疗效的直接原因。脑动脉瘤夹闭术中破裂难以完全避免,注意术中各环节的预防及合理使用应急对策可有效预防动脉瘤术中破裂出血。

Prevention and Treatment of Intraoperative Intracranial Aneurysm Rupture

Objective To explore the prevention and treatment of intraoperative Intracranial aneurysm rupture. Methods We retrospectively analyzed 57 cases of intracranial aneurysms. In accordance with the different locations,sizes and topographies of the aneurysms,exposure of cervical carotid artery and temporary parent artery occlusion were used to prevent the rupture of aneurysms. When the aneurysm ruptured,parent artery was occluded or the aneurysm was trapped,and then the aneurysm was properly treated. Results There were 12 cases of aneurysm rupture,accounting for 21% of the total aneurysms in the same time frame. 8 cases were clipped,trapped or excised.4 cases died after operation. Conclusions The improper surgical methods may increase the opportunity of premature aneurysmal rupture during operation; acute encephalocele after rupture and secondary injury due to blinded surgical management may influence surgical effects directly. Intracranial aneurysmal rupture during clip operations may be impossibly avoided,to pay attention to preventive methods and reasonable usage of emergent managements may decrease incidence of rupture and improve prognosis.