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近年来,我院共行可脱性弹簧血管内栓塞颅内动脉瘤126例132个.其中,机械可脱性弹簧圈(Machenical detachable spiral,MDS)85例90个动脉瘤,电熔可脱性弹簧圈(Guglielmi detachable coil,GDC)栓塞41例42个动脉瘤.用MDS栓塞的85例90个动脉瘤中,有3例3个动脉瘤在栓塞过程中动脉瘤发生破裂.3例动脉瘤均为使用MDS栓塞过程中发生的破裂,1例前交通动脉瘤栓塞的第一个弹簧逸出动脉瘤,解脱后迅速放置第二、三个弹簧闭塞动脉瘤.1例后交通动脉瘤放置弹簧时,弹簧末端有约1/3逸出动脉,小心将弹簧退入动脉瘤内盘旋后解脱迅速填充第二、三个弹簧,直至动脉瘤全部填塞.用GDC栓塞的41例42个动脉瘤中,有1例1个动脉瘤在栓塞过程中动脉瘤发生破裂.栓塞过程中动脉瘤破裂的原因:(1)动脉瘤反复多次破裂出血,形成不完全性假性动脉瘤,动脉瘤壁不完整且短期内迅速增大,弹簧易逸出动脉瘤;(2)动脉瘤颈部多次出血,瘤颈部极薄,脆性大,导管路过动脉瘤颈时造成瘤颈损伤;(3)微导管进入动脉瘤过程中,操作不规范,导管或导丝刺破动脉瘤;(4)微导管末端抵动脉瘤壁,强行推进弹簧时,损伤动脉瘤壁.术中预防动脉瘤破裂的措施:(1)术中操作轻
In recent years, our hospital a total of 132 cases of detachable intra-arterial embolization of intracranial aneurysm in 126 cases.Among them, mechanical detachable coil (Machenical detachable spiral, MDS 85 cases of 90 aneurysms, electrofusion detachable 41 cases of 42 aneurysms were embolized with Guglielmi detachable coil (GDC) .Among three aneurysms of 85 aneurysms embolized with MDS, aneurysms ruptured in 3 of 3 aneurysms during embolization.All three aneurysms In order to use the rupture that occurred during the embolization of the MDS, the first spring of an aneurysm embolism in one case escaped the aneurysm, and the second and third spring-occluded aneurysms were quickly placed after release.One case of a posterior communicating aneurysm , The spring end of about 1/3 out of the artery, the spring back into the aneurysm caudal caudal excretion quickly filled the second and third springs, until the aneurysm full of stuffing.With 41 cases of 42 aneurysms embolized with GDC, One case of aneurysm ruptured during embolization in 1 case.Anema rupture during embolization: (1) Aneurysm repeatedly ruptured and hemorrhage, the formation of incomplete pseudoaneurysm, the aneurysm wall is incomplete And rapidly increase in the short term, the spring is easy to escape aneurysm; (2) aneurysm neck Department of multiple bleeds, the neck of the neck is extremely thin, brittle, catheter neck caused by aneurysm neck tumor damage caused; (3) microcatheter into the aneurysm process, the operation is not standardized, catheter or guide wire aneurysm rupture; ( 4) The end of the microcatheter against the aneurysm wall, forcibly advance the spring, damage the aneurysm wall. Intraoperative prophylaxis of aneurysm rupture measures: (1) intraoperative and operative light