[1]李监松 骆 成 彭 磊 吴 永 许 勇 王 成 赵鹏洲 方 胜.颅内动脉瘤显微夹闭术中临时阻断技术的应用技巧[J].中国临床神经外科杂志,2020,(05):265-267.[doi:10.13798/j.issn.1009-153X.2020.05.003]
 LI Jian-song,LUO Cheng,PENG Lei,et al.Application of temporary parent artery occlusion during clipping intracranial aneurysms[J].,2020,(05):265-267.[doi:10.13798/j.issn.1009-153X.2020.05.003]
点击复制

颅内动脉瘤显微夹闭术中临时阻断技术的应用技巧()
分享到:

《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2020年05期
页码:
265-267
栏目:
论著
出版日期:
2020-05-25

文章信息/Info

Title:
Application of temporary parent artery occlusion during clipping intracranial aneurysms
文章编号:
1009-153X(2020)05-0265-03
作者:
李监松 骆 成 彭 磊 吴 永 许 勇 王 成 赵鹏洲 方 胜
529000 广东,江门市人民医院神经外科(李监松、赵鹏洲、方 胜),放射科(骆 成);241000 安徽,芜湖市第二人民医院神经外科(彭 磊、吴 永、许 勇、王 成)
Author(s):
LI Jian-song LUO Cheng PENG Lei WU Yong XU Yong WANG Cheng ZHAO Peng-zhou FANG Sheng.
Department of Neurosurgery, Jiangmen People's Hospital, Guangdong 529000, China
关键词:
颅内动脉瘤显微夹闭术载瘤动脉临时阻断血流动力学脑梗死
Keywords:
Intracranial aneurysms Clipping Temporary parent artery occlusion Cerebral infarction
分类号:
R 743.9; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2020.05.003
文献标志码:
A
摘要:
目的 探讨颅内动脉瘤显微夹闭术中载瘤动脉临时阻断技术所致瘤内相关血流动力学变化规律及其应用技巧。方法 回顾性分析2014年1月至2018年12月显微夹闭术治疗的55例(55个)颅内动脉瘤的临床资料,总结术中载瘤动脉临时阻断经验。术后24~48 h头颅CT检查临时阻断区有无新发梗死灶作为判断与临时阻断技术相关联的并发症。结果 载瘤动脉临时阻断以近端阻断为主,共48例;近、远端同时阻断共7例。术中载瘤动脉阻断时间2~20 min,平均(6.1±2.3)min。持续阻断共43例,间接阻断12例,间接阻断次数2~3次,间隔3~5 min。术后7例出现新发梗死灶,其中后交通动脉动脉瘤3例,大脑中动脉动脉瘤2例,前交通动脉动脉瘤2例。结论 颅内动脉瘤显微夹闭术中载瘤动脉临时阻断可造成动脉瘤内明显的血流动力学变化,术后早期继发性梗死灶与临时阻断技术密切相关
Abstract:
Objective To investigate the hemodynamic changes in aneurysms caused by temporary parent artery occlusion (TAO) during clipping the intracranial aneurysms and the skills of TAO. Methods The clinical data of 55 patients (55 aneurysms) with intracranial aneurysm who were treated by clipping from January 2014 to December 2018 were retrospectively analyzed, and the experience of TAO during the operation was summarized. The CT examination was used to detect the new cerebral infarction associated with the TAO 24 to 48 hours after the operation. Results The TAO was performed in the proximal segment of parent artery of 48 patients, and the proximal combined with distal of 7 patients. The time of TAO ranged from 2 to 20 minutes, with an average of (6.1 ± 2.3) minutes. Of these 55 patients, 43 patients received continuous occlusion and 12 intermittent occlusion (number of occlusion ranging from 2 to 3, interval time ranging from 3 to 5 minutes). New cerebral infarction occurred in 7 patients, including 3 posterior communicating artery aneurysms, 2 middle cerebral artery aneurysms and 2 anterior communicating artery aneurysms. Conclusions TAO can cause significant hemodynamic changes in the aneurysms. Early postoperative secondary cerebral infarction is closely related to the TAO

参考文献/References:

[1] Jabbour PM. Neurovascular surgical techniques [M]. Phila- delphia: Jaypee Brothers Medical Publishers, 2013. 202- 221.
[2] Lawton MT. Seven Aneurysms Tenets and Techniques for Clipping [M]. New York: Thieme Medical Publishers, 2011. 12-15.
[3] Lawton MT. Seven Bypasses Tenets and Techniques for Revascularization [M]. New York: Thieme Medical Publi- shers, 2018. 164-168.
[4] Esposito G, Fierstra J, Regli L. Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms [J]. Acta Neurochir (Wien), 2016, 158(8): 1523-1531.
[5] 孙正辉,许百男,周定标,等. 载瘤动脉临时阻断处理颅内 动脉瘤的临床研究[J]. 中华神经外科杂志,2003,19(5): 361-363.
[6] Tanabe J, Ishikawa T, Moroi J, et al. Preliminary study on safe thresholds for temporary internal carotid artery occlu- sion in aneurysm surgery based on mot-evoked potential monitoring [J]. Surg Neurol Int, 2014, 5: 47.
[7] Tanabe J, Ishikawa T, Moroi J. Safe time duration for tempo- rary middle cerebral artery occlusion in aneurysm surgery based on motor-evoked potential monitoring [J]. Surg Neurol Int, 2017, 8: 79.
[8] Sasaki T, Kodama N, Matsumoto M, et al. Blood flow distur- bance in perforating arteries attributable to aneurysm sur- gery [J]. J Neurosurg, 2007, 107(1): 60-67.
[9] Shojima M, Morita A, Kimura T, et al. Computational fluid dynamic simulation of a giant basilar tip aneurysm with eventual rupture after hunterian ligation [J]. World Neuro- surg, 2014, 82(3-4): 535.e5-9.
[10] Pasqualin A, Meneghelli P, Musumeci A, et al. Intraopera- tive measurement of arterial blood flow in aneurysm surgery [J]. Acta Neurochir Suppl, 2018, 129: 43-52.

相似文献/References:

[1]许 州 李明昌 陈谦学.低位型后交通动脉动脉瘤显微夹闭术中前床突磨除的意义[J].中国临床神经外科杂志,2017,(11):773.[doi:10.13798/j.issn.1009-153X.2017.11.013]
[2]陈善文 邢安凤 王 硕.颈内动脉血泡样动脉瘤的显微夹闭术效果评价[J].中国临床神经外科杂志,2018,(04):228.[doi:10.13798/j.issn.1009-153X.2018.04.002]
 CHEN Shan-wen,XING An-feng,WANG Shuo..Curative effects of microsurgical clipping on blister-like aneurysms of internal carotid artery (report of 15 cases)[J].,2018,(05):228.[doi:10.13798/j.issn.1009-153X.2018.04.002]
[3]幸 标 彭占威 李 俊.前交通动脉动脉瘤夹闭术后并发中枢性尿崩症的危险因素[J].中国临床神经外科杂志,2019,(10):586.[doi:10.13798/j.issn.1009-153X.2019.10.003]
 XING Biao,PENG Zhan-wei,LI Jun..Analysis of factors related to central diabetes insipidus after clipping of anterior communicating artery aneurysms[J].,2019,(05):586.[doi:10.13798/j.issn.1009-153X.2019.10.003]
[4]蔡俊杰 孔 滨 苑玉清.颅内动脉瘤夹闭术中动脉瘤破裂的危险因素分析[J].中国临床神经外科杂志,2020,(03):149.[doi:10.13798/j.issn.1009-153X.2020.03.007]
 CAI Jun-jie,KONG Bin,YUAN Yu-qing..Risk factors of aneurysm rupture during clipping in patients with intracranial aneurysm[J].,2020,(05):149.[doi:10.13798/j.issn.1009-153X.2020.03.007]
[5]杨 丽 张庭保 李正伟 王 蓓 赵文元 李志强 陈劲草.ERAS在颅内动脉瘤显微夹闭术中的应用[J].中国临床神经外科杂志,2020,(07):474.[doi:10.13798/j.issn.1009-153X.2020.07.020]
[6]钟伟健 廖旭兴 董安石 刘鑫鑫 罗 杰 周思捷 梁铭钦 王 辉.T型动脉瘤夹夹闭颅内破裂宽颈微小动脉瘤24例[J].中国临床神经外科杂志,2021,26(04):288.[doi:10.13798/j.issn.1009-153X.2021.04.020]
[7]向春晖 田仁富 潘 轲.小翼点入路手术夹闭前循环动脉瘤42例[J].中国临床神经外科杂志,2021,26(05):367.[doi:10.13798/j.issn.1009-153X.2021.05.016]
[8]张道宝 陈 舒 吴虹刚 游国亮 雷 波 万晓强 郑念东.改良Paine点穿刺脑室外引流术及终板造瘘术在颅内前循环破裂动脉瘤急性期夹闭术中的应用[J].中国临床神经外科杂志,2021,26(07):527.[doi:10.13798/j.issn.1009-153X.2021.07.010]
 ZHANG Dao-bao,CHEN Shu,WU Hong-gang,et al.Application of extraventricular drainage through modified Paine point puncture and lamina terminalis fenestration during clipping ruptured intracranial anterior circulation aneurysms at acute stage[J].,2021,26(05):527.[doi:10.13798/j.issn.1009-153X.2021.07.010]
[9]陈 俊 刘 融 邹 雅 周赤忠.基于颅脑CTA的3D打印技术在颅内动脉瘤夹闭术中的应用[J].中国临床神经外科杂志,2021,26(08):632.[doi:10.13798/j.issn.1009-153X.2021.08.019]
[10]黄 伟 曾 括 幸 标等.胼周动脉动脉瘤42例治疗分析[J].中国临床神经外科杂志,2021,26(09):662.[doi:10.13798/j.issn.1009-153X.2021.09.002]
 HUANG Wei,ZENG Kuo,XING Biao,et al.Microsurgical and endovascular treatment for patients with pericallosal artery aneurysm[J].,2021,26(05):662.[doi:10.13798/j.issn.1009-153X.2021.09.002]
[11]卢春李 丰育功.显微夹闭术和血管内栓塞治疗颅内后循环动脉瘤的疗效比较[J].中国临床神经外科杂志,2020,(05):261.[doi:10.13798/j.issn.1009-153X.2020.05.002]
 LU Chun-li,FENG Yu-gong..Comparison of curative effect between microsurgical clipping and endovascular embolization for intracranial posterior circulation aneurysms[J].,2020,(05):261.[doi:10.13798/j.issn.1009-153X.2020.05.002]

备注/Memo

备注/Memo:
(2019-10-23收稿,2019-12-06修回)
更新日期/Last Update: 1900-01-01