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目的 探讨电解可脱弹簧圈 (GDC)治疗颅内动脉瘤的手术指征、术前评估方法、技术操作要点、并发症防治、疗效、存在问题及临床应用前景。方法 1998年 7月至 2 0 0 0年 2月对 93例 118个颅内动脉瘤患者施行了电解可脱卸弹簧圈栓塞术 ,其中 84例为破裂动脉瘤 ,按Hunt Hess分级 :Ⅰ级 18例 ,Ⅱ级 2 9例 ,Ⅲ级 2 5例 ,Ⅳ级 10例 ,Ⅴ级 2例。 72例行急诊栓塞 ,手术在DSA动态监视下完成 ,术后腰椎蛛网膜下腔持续引流 ,并予以 3H(高血容量、高血压、血液稀释 )治疗。结果 动脉瘤完全闭塞 10 4个 (88 14% ) ,栓塞程度达 90 %以上 11个 (9 32 % ) ,栓塞程度在 90 %以下 3个 (2 5 4% )。全组死亡 3例 (3 2 3% )。 1例术后 1 5个月复发出血经手术夹闭痊愈 ,2例术后复查发现瘤颈扩大 ,经再次填塞后痊愈。术后随访 2～ 2 2个月 ,1例 (1 0 7% )重残 ,7例 (7 5 3% )有轻度神经功能缺失症状 ,其余恢复良好。结论 短期随访结果表明 ,GDC栓塞颅内动脉瘤具有微创、安全、效果可靠的优点。致密填塞动脉瘤疗效可靠 ,部分填塞可能导致动脉瘤继续扩大、破裂出血。破裂动脉瘤应急诊栓塞治疗 ,术后腰椎蛛网膜下腔持续引流 ,可明显提高疗效。
Objective To investigate the surgical indications, preoperative evaluation methods, technical operation points, prevention and treatment of complications, curative effects, existing problems and clinical application prospects of the treatment of intracranial aneurysms with Electrolytic Detachable Coils (GDC). Methods From July 1998 to February 2000, 93 patients with 118 patients with intracranial aneurysms were treated with electrolytically detachable coil embolization, of which 84 were ruptured aneurysms. According to the Hunt Hess classification, grade Ⅰ was 18 29 cases of grade Ⅱ, 25 cases of grade Ⅲ, 10 cases of grade Ⅳ and 2 cases of grade Ⅴ. Seventy - two patients underwent emergency embolization. The operation was performed under the dynamic surveillance of DSA. The lumbar subarachnoid space was continuously drained and treated with 3H (hypercapnia, hypertension and hemodilution). Results A total of 104 aneurysm occlusions (88 14%) were occured, 11 (9 32%) were occluded more than 90% and 3 (24 4%) were occluded less than 90%. The whole group died in 3 cases (32.3%). One case had recurrence of hemorrhage 15 months after operation and was cured by surgical clipping. Two cases were found to be enlarged by recanalization and recovered after filling again. The patients were followed up for 2 to 22 months. One case (107%) was severely disabled and the other 7 cases (75.3%) had mild neurological deficit. The rest recovered well. Conclusion Short-term follow-up results show that GDC embolization of intracranial aneurysms with minimally invasive, safe, reliable results. Tight aneurysm aneurysm effective and reliable, part of the stuffing may lead to aneurysms continue to expand, rupture and bleeding. Ruptured aneurysm emergency diagnosis and embolization treatment, continuous lumbar subarachnoid drainage, can significantly improve the curative effect.