血管内治疗中颅内动脉瘤破裂的诊断与处理

目的 探讨颅内动脉瘤栓塞过程中发生破裂之原因,以及诊断、处理与预后评估。方法回顾分析了1994年5月～2002年6月420例接受血管内栓塞治疗的颅内动脉瘤患者的临床资料,其中15例于手术过程中动脉瘤发生破裂(因导管穿破瘤壁者3例,弹簧圈穿破瘤壁者8例,高压注射致破裂者1例,不明原因者3例),经脑血管造影确诊后即刻加深麻醉、迅速致密栓塞动脉瘤井给予鱼精蛋白逆转肝素化,或行脑室外引流及颅内血肿清除术。结果 15例手术中动脉瘤破裂的患者,经治疗后完全康复11例,轻度致残1例、死亡3例。结论 颅内动脉瘤栓塞过程中破裂是血管内介入治疗的严重并发症,破裂主要与动脉瘤的形态及结构有关,缺乏临床经验也是导致术中破裂原因之一。其预后取决于出血量的多少、患者手术前状态以及迅速而正确的救治。

Diagnosis and management of intracranial aneurysm rupture during endovascular embolization

Objective To study the causes, diagnosis, management and prognosis of aneurysm rupture during endovascular embolization. Methods The records of 420 patients with intracranial aneurysm received endovascular embolization during May 1994-June 2002 were retrospectively analyzed. Among these patients 15 cases of aneurysm rupture occurred during embolizing treatment (caused by penetration of catheter 3 cases, coil Scases, high pressure injection 1 case, unknown reason 3 cases). Immediate deepening anesthesia was performed after definite diagnosis of aneurysm rupture by cerebrovascular angiography. Then treatment with rapid completion of densely embolizing the aneurysm, and reversing heparinization with protamine, or extra-ventricular drainage and evacuation of intracranial hematoma were performed. Results Of these 15 cases with aneurysm, 11 cases with good recovery, 1 case sustaining permanent neurological deficit and 3 cases died were resulted after treatment. Conclusion Intracranial aneurysm rupture is the life-threatening complication during endovascular coil embolization and mainly relates to the aneurysm structural and morphological features. Less clinical experience may be one of the factors resuted in aneurysm rupture during operation. Prognosis of these patients depends on preoperative health status, the extent of bleeding, and appropriate treatment without delay.