显微夹闭颅内前循环动脉瘤术中动脉瘤破裂的处理

目的探讨显微夹闭颅内前循环动脉瘤术中动脉瘤破裂出血的处理策略,方法回顾性分析2003年1月至2010年1月56例前循环颅内动脉瘤患者开颅显微手术夹闭的临床资料,结合文献对13例术中发生动脉瘤破裂出血的处理经验和技巧进行总结.结果 56例接受开颅夹闭的动脉瘤病人中,有13例出现术中动脉瘤破裂,均得以妥善处理,术后GOS 5分（恢复良好,能够恢复工作或学习）39例;GOS 4分（轻残,能够独立生活,不能恢复工作或学习）8例;GOS3分（重残,能够按吩咐动作,但不能独立生活）6例;GOS2分（植物状态,不能与外界互动,无反应）0例;GOS 1分（住院死亡）3例.结论应从麻醉、开颅到手术操作的各个环节尽量防范术中动脉瘤破裂,合理、间断和短时应用载瘤动脉临时阻断技术,可有效处理和防范术中动脉瘤破裂的危急情况.

The Treatment of Cerebral Anterior Circulation Aneurysm Rupture during Microoperation

Objective To explore the prevention,surgical technique,and comprehensive measures of cerebral anterior circulation aneurysm rupture during operation.Methods A retrospective analysis was made among 56 patients with cerebral anterior circulation aneurysm operation from January 2003 to January 2010.The prevention,surgical technique and comprehensive measures in 13 aneurysm rupture during operation were reviewed.Results 13 patients with aneurysm rupture during operation were treated properly in 56 patients.According to postoperative GOS,there were 39 cases as GOS 5,8 cases as GOS 4,6 cases as GOS 3,and 3 cases as GOS 1.Conclusion The preventing measures of aneurysm rupture during operation should be taken as possible during anesthesia,craniotomy and operation.Temporary occlusion of parent artery as emergency measure can prevent and treat aneurysm rupture during operation effectively,but it should be taken in short,intermittently and reasonably.