[1]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):527-528.[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(07):527-528.[doi:10.13798/j.issn.1009-153X.2021.07.010]
点击复制

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()
分享到：

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

卷:
26
期数:
2021年07期
页码:
527-528
栏目:
论著
出版日期:
2021-07-25

文章信息/Info

Title:
Application of extraventricular drainage through modified Paine point puncture and lamina terminalis fenestration during clipping ruptured intracranial anterior circulation aneurysms at acute stage
文章编号:
1009-153X（2021）07-0527-02
作者:
张道宝　陈　舒　吴虹刚　游国亮　雷　波　万晓强　郑念东
614000 四川，乐山市人民医院脑血管病科（张道宝、陈　舒、吴虹刚、游国亮、雷　波、万晓强、郑念东）
Author(s):
ZHANG Dao-bao;  CHEN Shu;  WU Hong-gang;  YOU Guo-liang;  LEI Bo;  WAN Xiao-qiang;  ZHENG Nian-dong.
Department of Cerebrovascular Diseases, The People’s Hospital of Leshan City, Leshan 614000, China
关键词:
颅内破裂动脉瘤; 前循环; 显微夹闭术; Paine点穿刺脑室外引流术; 终板造瘘术; 疗效
Keywords:
Ruptured intracranial aneurysm;  Anterior circulation;  Clipping;  Extraventricular drainage;  Lamina terminalis fenestration;  Clinical efficacy
分类号:
R 743.9; R 651.1+2
DOI:
10.13798/j.issn.1009-153X.2021.07.010
文献标志码:
A
摘要:
目的 探讨Paine点穿刺脑室外引流术及终板造瘘术在颅内前循环动破裂脉瘤急性期夹闭术中的应用效果。方法 回顾性分析2017年1月至2019年12月急性期显微夹闭治疗的85例颅内前循环破裂动脉瘤的临床资料，术中采用Paine点穿刺脑室外引流术及终板造瘘术。结果 85例中，81例改良Paine点穿刺顺利，4例穿刺失败；11例因动脉瘤夹闭后仍见脑组织塌陷不佳，行终板造瘘术，并保留脑室外引流3~5 d，其中3例行去骨瓣减压术。术后复查CTA或DSA，4例前交通动脉动脉瘤、5例大脑中动脉动脉瘤的瘤颈有少许残留，其余动脉瘤均夹闭完全。术后随访半年，8例失访，其余77例复查CTA未见动脉瘤复发；GOS评分5分72例，4分3例，3分2例；1例出现脑积水并行脑室-腹腔分流术。结论 颅内前循环破裂动脉瘤急性期夹闭术中，改良Paine点穿刺脑室外引流术、终板造瘘术有利于充分释放脑脊液，降低颅内压，充分暴露动脉瘤，改善夹闭术治疗的效果。
Abstract:
Objective To explore the clinical efficacy of extraventricular drainage through modified Paine point puncture (EVD-P) and lamina terminalis fenestration (LTF) during clipping the ruptured intracranial anterior circulation aneurysms (r-IACA) at acute stage. Methods The clinical data of 85 patients with r-IACA who underwent clipping assissted by intraoperative EVD-P and LTF at acute stage between January 2017 and December 2019 were analyzed retrospectively. Results EVD-P was successfully performed on 81 patients and failed in 4. LTF with extraventricular drainage for 3~5 days was performed on 11 patients, of whom 3 underwent decompression, due to poor brain tissue collapse after aneurysm clipping. Postoperative CTA or DSA showed few neck residues in 4 patients with anterior communicating artery aneurysm and 5 patients with middle cerebral artery aneurysm, and complete occlusion of aneurysm in other 77 patients. The 6-month follow up of 77 patients showed no reccurrence, and GOS score of 5 in 72 patients, score of 4 in 3 and score of 3 in 2. Conclusions During clipping the r-IACA at acute stage, EDV-P and LTF are helpful to improving the patients’ prognoses by fully release of cerebrospinal fluid, reduce in intracranial pressure, and fully exposure of aneurysm.

参考文献/References:

[1] 梁　勇. 破裂动脉瘤术中脑室穿刺留置外引流的技术探讨[J]. 中国微侵袭神经外科杂志，2015，20（1）：10-11.
[2] Haley EC Jr, Kassell NF, Torner JC. The international coo-perative study on the timin of aneuysm surgery [J]. Stroke,1992, 23(2): 205-214.
[3] 王晓亮，徐传林，杨道明，等. Paine点穿刺应用在夹闭破裂前交通动脉瘤的疗效分析[J]. 中国医师进修杂志，2015，38（7）：531-532.
[4] 罗文伟，王晓亮，杨道明，等. 改良 Paine 点脑室穿刺协助早期颅内动脉瘤破裂显微手术 67例临床分析[J]. 中国医师进修杂志，2016，39（8）：704-707.
[5] 王晓刚，梁国标，梁　勇. 破裂动脉瘤术中脑室穿刺留置外引流的技术探讨[J]. 中国微侵袭神经外科杂志，2015，20（1）：10-11.
[6] 许百男，段国升，张　纪，等. 颅内动脉瘤术中破裂的原因方式预防及处理[J]. 中华神经外科杂志，1994，10（3）：141-143.
[7] 乞绍岚，张晓东，李　扩，等. 侧脑室穿刺 Paine 点改良的解剖基础及临床应用[J]. 华西医学，2011，26：1153-1155.
[8] 李栋良，白　华，牟晓洋. 动脉瘤术中通过额后静脉寻找 Paine点的体会[J]. 中华神经外科疾病研究杂志，2018，17（6）：554-555.
[9] 罗文伟，鲍玉海，王晓亮，等. 改良Paine点脑室穿刺协助治疗早期破裂颅内动脉瘤[J]. 中国实用医刊，2016，43（22）：61-63.
[10] 朱海林，张　洋. 改良Paine点脑室穿刺应用破裂动脉瘤夹闭术治疗动脉瘤性蛛网膜下腔出血的疗效观察[J]. 中国实用医刊，2018，5（76）：34-35.
[11] 连泽豪，付卯宏，曹新生. 改良Paine点脑室穿刺应用破裂动脉瘤夹闭术治疗动脉瘤性蛛网膜下腔出血的疗效观察[J]. 中国实用医药，2016，11（4）：57-58.
[12] 金保哲，张新中，周国胜，等. 动脉瘤夹闭术中终板造瘘预防慢性脑积水[J]. 中华神经外科杂志，2008，24：611-613.
[13] 彭四维，漆松涛，冯文峰，等. 早期终板造瘘治疗动脉瘤性蛛网膜下腔出血后急性脑积水的疗效[J]. 中华神经外科杂志，2015，31（2）：169-172.
[14] 张　力，王汉东，潘云曦，等. 前交通动脉瘤破裂合并颅内血肿的超早期显微手术治疗结果分析[J]. 医学研究生学报，2019，16（6）：303-309.

相似文献/References:

[1]张晓燕　张　穗　宋利亚.颅内破裂动脉瘤急诊夹闭术围手术期护理[J].中国临床神经外科杂志,2016,(05):308.[doi:10.13798/j.issn.1009-153X.2016.05.019]
[2]吴有志　罗良生　张　健　陈　骅　吴　鸣　刘　振　史　岩.前循环破裂动脉瘤伴脑内血肿的 早期显微手术治疗[J].中国临床神经外科杂志,2016,(06):376.[doi:10.13798/j.issn.1009-153X.2016.06.020]
[3]伍　杰　杨　铭　潘　力　蔡明俊　刘　鹏　秦　杰　杨　柳　安学锋　李国栋　马廉亭.颅内破裂动脉瘤合并脑内血肿的复合手术治疗[J].中国临床神经外科杂志,2016,(04):193.[doi:10.13798/j.issn.1009-153X.2016.04.001]
　WU Jie,YANG Ming,PAN Li,et al.Clinical observation of hybrid surgery on ruptured intracranial aneurysms associated with cerebral hematomas (report of 5 cases)[J].,2016,(07):193.[doi:10.13798/j.issn.1009-153X.2016.04.001]
[4]符传艺　陈健龙　张　茂　刘朝晖　黄垂学　黄　军　马建荣　赵建农.表现为脑室出血的颅内破裂动脉瘤的诊治[J].中国临床神经外科杂志,2016,(04):234.[doi:10.13798/j.issn.1009-153X.2016.04.014]
[5]郑鉴峰　郭宗铎　张晓冬　朱　继　何朝晖　孙晓川.开颅夹闭术和血管内栓塞术治疗老年前交通动脉破裂动脉瘤的疗效对比分析[J].中国临床神经外科杂志,2016,(03):150.[doi:10.13798/j.issn.1009-153X.2016.03.006]
　ZHENG Jian-feng,GUO Zong-duo,ZHANG Xiao-dong,et al.Craniotomy clipping and interventional treatment of ruptured anterior communicating artery aneurysms in elderly patients: comparison of curative effects[J].,2016,(07):150.[doi:10.13798/j.issn.1009-153X.2016.03.006]
[6]李玉龙　方兴根　李真保　吴德刚　赖年升　赵心同　徐善水　狄广福.血管内治疗颈内动脉床突旁破裂动脉瘤[J].中国临床神经外科杂志,2016,(02):79.[doi:10.13798/j.issn.1009-153X.2016.02.006]
　LI Yu-long,FANG Xing-gen,LI Zhen-bao,et al.Endovascular embolization of ruptured paraclinoid aneurysms (report of 26 cases)[J].,2016,(07):79.[doi:10.13798/j.issn.1009-153X.2016.02.006]
[7]胡　骁　周林裕　王　克　邓剑平　赵振伟.支架辅助血管内栓塞前交通动脉破裂动脉瘤的疗效[J].中国临床神经外科杂志,2016,(02):82.[doi:10.13798/j.issn.1009-153X.2016.02.007]
　HU Xiao,ZHOU Lin-yu,WANG Ke,et al.Curative effect of stent-assisted endovascular embolization on ruptured anterior communicating artery aneurysms[J].,2016,(07):82.[doi:10.13798/j.issn.1009-153X.2016.02.007]
[8]申汉威　李俊卿　李红星　汪立刚　杨孔宾.颅内破裂动脉瘤夹闭术与血管内栓塞术后脑积水发生率的比较分析[J].中国临床神经外科杂志,2015,(03):140.[doi:10.13798/j.issn.1009-153X.2015.03.004]
　SHEN Han-wei,LI Jun-qing,LI Hong-xing,et al.Clinical study and Meta-analysis of incidences of hydrocephalus after microsurgery and endovascular embolization in patients with ruptured intracranial aneurysms[J].,2015,(07):140.[doi:10.13798/j.issn.1009-153X.2015.03.004]
[9]李　明,党　伟,胡志卿,等.早期栓塞和手术夹闭颅内破裂动脉瘤的疗效及安全性[J].中国临床神经外科杂志,2016,(12):759.[doi:10.13798/j.issn.1009-153X.2016.12.009]
　LI Ming,DANG Wei,HU Zhi-qing,et al.Evaluation of effect of early interventional treatment on ruptured incranial aneurysms and its safety[J].,2016,(07):759.[doi:10.13798/j.issn.1009-153X.2016.12.009]
[10]吴　阳　李　明　王　斌　刘义峰　李　巍.血管内栓塞治疗颅内破裂动脉瘤的近期疗效及其对患者免疫功能的影响[J].中国临床神经外科杂志,2017,(01):17.[doi:10.13798/j.issn.1009-153X.2017.01.006]
　WU Yang,LI Ming,WANG Bin,et al.Short-term curative effect of endovascular embolization on ruptured intracranial aneurysms and its influence upon immune function[J].,2017,(07):17.[doi:10.13798/j.issn.1009-153X.2017.01.006]
[11]王玉贵　李朝晖　郭永川　贾翊平　梁世鹏　刘德华.眶上外侧入路与翼点入路显微手术治疗急性期前循环破裂动脉瘤的对比分析[J].中国临床神经外科杂志,2016,(08):452.[doi:10.13798/j.issn.1009-153X.2016.08.002]
　WANG Yu-gui,LI Chao-hui,GUO Yong-chuan,et al.Microsurgery through lateral supraorbital approach for acute ruptured anterior circulation aneurysms[J].,2016,(07):452.[doi:10.13798/j.issn.1009-153X.2016.08.002]
[12]邓民强　潘　轲　田仁富　王国堰　向春晖.眶上外侧入路与翼点入路手术治疗急性期颅内前循环破裂动脉瘤的临床对比分析[J].中国临床神经外科杂志,2016,(10):606.[doi:10.13798/j.issn.1009-153X.2016.10.012]
　DENG Min-qiang,PAN Ke,TIAN Ren-fu,et al.Microsurgery for ruptured intracranial anterior circulation aneurysms at acute stage: supraorbital lateral approach vs. pterional approach[J].,2016,(07):606.[doi:10.13798/j.issn.1009-153X.2016.10.012]

备注/Memo

备注/Memo:
通讯作者：郑念东，E-mail：278406847@qq.com
更新日期/Last Update: 2021-07-25