老年性前循环动脉瘤的神经外科治疗.docVIP

老年性前循环动脉瘤的神经外科治疗 　　[摘要] 目的 探讨65岁以上老年性前循环动脉瘤显微神经外科手术治疗的可行性和术后综合治疗策略。 方法 回顾性分析2000年1月～2013年10月北京中医药大学东方医院33例65岁以上老年性颅内动脉瘤患者的临床资料，其中采用急性期手术治疗2例，早期手术治疗15例，延期手术治疗16例。术中采用15 min以内控制性低血压，充分利用显微外科技术及脑动脉解剖间隙进入术区、术中积极采用罂粟碱棉片及尼莫同盐水冲洗保护血管技术，术后尽早应用中西医结合技术综合治疗。观察其显微神经外科手术治疗及术后综合治疗结果。 结果 本组33例患者33枚动脉瘤，显微手术夹闭31枚，包裹修补2枚，术中动脉瘤破裂1例。术后并发症：术后24 h额叶脑梗塞4例，肢体不同程度瘫痪加重4例， 肺部感染4例，电解质紊乱5例，消化道出血5例。术后3个月随访，ADLⅠ级10例，Ⅱ级12例，Ⅲ级9例，Ⅳ级2例，Ⅴ级0例。 结论 先进的显微神经外科手术结合术后中西医结合治疗可以有效治疗老年性前循环颅内动脉瘤。 　　[关键词] 老年性前循环动脉瘤；显微外科；手术；综合治疗 　　[中图分类号] R651.12 [文献标识码] A [文章编号] 1673-7210（2014）04（a）-0038-03 　　Neurosurgery treatment of senile anterior circulation aneurysms 　　WEI Pengxiang LIU Jialin▲ ZHOU Yujia WANG Lei 　　Department of Neurosurgery， Orient Hospital of Beijing University of Chinese Medicine， Beijing 100078， China 　　[Abstract] Objective To explore the operation treatment feasibility of microneurosurgery and comprehensive treatment of postoperation in elderly aged more than 65 years with anterior circulation aneurysms. Methods Clinical data of 33 patients over 65 years old with intracranial aneurysms from January 2000 to October 2013 in Orient Hospital of Beijing University of Chinese Medicine were retrospective analyzed， there were 2 cases with acute stage of operation， 15 cases with early stag operation treatment， and 16 cases with delayed operation. Within 15 minutes of controlled hypotension was adopted， microsurgical techniques and cerebral artery anatomy space were fully used into the operation area， papaverine cotton sheets and Nimotop saline vascular protection technology were actively used during the operation， postoperative early application of integrated Chinese and western medicine comprehensive treatment were carried. The treatment results of microneuro surgery operation and postoperative comprehensive treatment were observed. Results There were 33 cases with 33 aneurysms， includes 31 microsurgery clipping operations and 2 parcel repair surgery， while intraoperative aneurysm rupture and bleedi