上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (10): 1330-.doi: 10.3969/j.issn.1674-8115.2012.10.011

• 论著（临床研究） • 上一篇    下一篇

颈内动脉腹侧动脉瘤手术夹闭技术

费智敏1, 张 珏1, 书国伟1, 蔡佩浩1, 王静予1, 李善泉2   

  1. 1.上海中医药大学附属曙光医院神经外科, 上海 201203； 2.上海交通大学 医学院附属仁济医院神经外科, 上海 200127
  • 出版日期:2012-10-28 发布日期:2012-11-05
  • 通讯作者: 张 珏, 电子信箱: zhangjue_sunrun@hotmail.com。
  • 作者简介:费智敏（1968—）, 男, 主任医师, 硕士；电子信箱: tommyfei@126.com。
  • 基金资助:

    上海市卫生局课题（2010139）和上海市教委课题（13ZZ094）

Surgical technique in clipping of ventral aneurysms in internal carotid artery

FEI Zhi-min1, ZHANG Jue1, SHU Guo-wei1, CAI Pei-hao1, WANG Jing-yu1, LI Shan-quan2   

  1. 1.Department of Neurosurgery, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China；2.Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2012-10-28 Published:2012-11-05
  • Supported by:

    Shanghai Municipal Health Bureau Foundation, 2010139；Shanghai Education Committee Foundation, 13ZZ094

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摘要：

目的 探讨颈内动脉腹侧动脉瘤手术夹闭技术。方法 分析10例经3D-CT血管造影(3D-CTA)和数字减影血管造影（DSA）检查证实的颈内动脉腹侧动脉瘤病例，术前模拟手术体位的3D-CTA确认瘤颈位置及指向，辨认瘤颈附近有无分支动脉，以便制定手术方案。术中行诱发电位和微血管多普勒监测，辅助神经内窥镜观察，如确认动脉瘤与颈内动脉的分支血管有密切关系，使用常规夹由颈内动脉两侧与颈内动脉长轴垂直方向将其夹闭，如无分支血管则使用套圈夹平行颈内动脉长轴夹闭，必要时可联合使用多枚瘤夹，重塑血管。结果 术后1个月时患者格拉斯哥预后评分：5分者8例，４分者1例，3分者1例，无死亡病例。所有患者术后3个月随访时，3D-CTA和（或）DSA复查动脉瘤夹闭完全，载瘤动脉通畅；发生永久性失明1例。结论 术前完善的影像学检查、术中各种辅助手段及正确的手术方法对手术夹闭颈内动脉腹侧动脉瘤至关重要。

关键词: 颈内动脉, 腹侧动脉瘤, 手术夹闭, 三维CT血管造影, 数字减影血管造影

Abstract:

Objective To investigate the technique in clipping of ventral aneurysms in internal carotid artery. Methods Ten cases of ventral aneurysms in internal carotid artery confirmed by 3D-CT angiography (3D-CTA) and digital subtraction angiography (DSA) were analysed. Preoperative virtual reality model of 3D-CTA, based on the body position during surgery, simulated the position of aneurysm and direction of doom and determine the existence of branching artery originating from the aneurysm or nearby parent artery. Somatosensory evoked potential monitoring, microvascular Doppler sonography, and neuroendoscopy were used before and after clipping to confirm the obliteration of aneurysms and patency of parent vessels and branching artery.If the branching artery was originating from the aneurysm, lateral side of internal carotid artery with nonring clip was recommended. Otherwise, it was often preferable to clip the aneurysm with ring or so-called fenestrated clip, whose clip-blades were placed parallel to internal carotid artery axis. If necessary, the combination use of several clips was recommended to reconstruct the parent artery. Results The scores of Glasgow Outcome Scale one month after operation were 5 points in 8 patients, 4 points in 1 patient and 3 points 1 patient. There was no case of death. Three months after operation,DSA and/or 3D-CTA revealed that there was no aneurysmal residue and no stenosis of parent and adjacent vessels. One patient suffered from permanent visual loss. Conclusion Detailed preoperative planning and proper intraoperative assisted methods and neuroendoscopy are important for clipping of ventral aneurysms in internal carotid artery.

Key words: internal carotid artery, ventral aneurysm, clipping, 3D-CT angiography, digital subtraction angiography