颅内动脉瘤破裂合并脑内血肿的早期手术治疗

张绍林 黄金生 罗文伟 王晓亮 杨道明 吴德骥

【摘要】 目的：探讨颅内动脉瘤破裂合并脑内血肿的早期手术治疗效果。方法：回顾性分析30例颅内动脉瘤破裂合并脑内血肿患者的临床资料，探讨早期显微外科手术夹闭动脉瘤并清除脑内血肿的临床效果和预后。术后当天复查颅脑CT，术后第1天复查CTA，术后3个月进行格拉斯哥预后评分（Glasgow outcome scale，GOS）评估预后，并进行定期随访。结果：30例患者共检查出32个动脉瘤，均成功夹闭动脉瘤的同时进行了血肿清除术，术后CTA复查未见动脉瘤瘤颈残留。术后发生肺部感染11例，颅内感染1例，脑积水3例，电解质紊乱6例，肢体偏瘫8例，应激性溃疡5例，癫痫1例。术后3个月，GOS 5分21例，GOS 4分6例，GOS 3分2例，GOS 2分1例，GOS 1分0例;规律随访，患者未再自发颅内蛛网膜下腔出血及动脉瘤复发。结论：颅内动脉瘤破裂合并脑内血肿，早期显微镜下夹闭动脉瘤的同时清除脑内血肿，患者预后较好。

【关键词】 显微外科手术 脑内血肿 颅内动脉瘤

doi：10.14033/j.cnki.cfmr.2019.29.022 文献标识码 B 文章编号 1674-6805（2019）29-00-03

[Abstract] Objective： To investigate the effect of early surgical treatment of intracranial aneurysm rupture combined with intracerebral hematoma. Method： The clinical data of 30 patients with intracranial aneurysm rupture combined with intracerebral hematoma were retrospectively analyzed. The clinical effect and prognosis of early microsurgery for clipping aneurysm and clearing intracerebral hematoma were discussed. Cranial CT was reviewed on the day after surgery， and CTA was reviewed on the first day after the surgery. The Glasgow outcome scale （GOS） was used to assess the prognosis 3 months after the surgery， and regular follow-up was conducted. Result： Thirty-two aneurysms were detected in 30 patients. All the aneurysms were successfully clipped and the hematoma was removed. Postoperative CTA reexamination showed no residual aneurysm neck. There were 11 cases of pulmonary infection， 1 case of intracranial infection， 3 cases of hydrocephalus， 6 cases of electrolyte disorder， 8 cases of limb hemiplegia， 5 cases of stress ulcer and 1 case of epilepsy. Three months after surgery， GOS in 5 points was 21 cases， GOS in 4 points was 6 cases， GOS in 3 points was 2 cases， GOS in 2 points was 1 case， GOS in 1 point 0 cases. Regular follow-up， no spontaneous subarachnoid hemorrhage and aneurysm recurrence occurred. Conclusion： Intracranial aneurysm rupture combined with was intracerebral hematoma， early microsurgery clipping aneurysm and clearance of intracerebral hematoma， the prognosis of the patients is better.

[Key words] Microsurgery Intracerebral hematoma Intracranial aneurysm

First-authors address： Nanping First Hospital Affiliated to Fujian Medical University， Nanping 353000， China

顱内动脉瘤是指颅内动脉管壁的瘤样膨出，动脉瘤破裂后引起颅内出血，其发病率仅次于脑梗死和高血压性脑出血的脑血管疾病。该病起病急、致死率和致残率高。动脉瘤破裂后血液流入蛛网膜下腔引起蛛网膜下腔出血，血液破入邻近脑组织内引起脑内血肿，合并脑内血肿的发生率约为15%[1-2]。合并脑内血肿的动脉瘤破裂患者，病情相对较危重，Hunt-Hess分级常为Ⅲ～Ⅴ级[3-4]。血肿量较小时，血肿可不必处理;血肿量较大时产生占位效应，可引起脑组织移位、颅高压，甚至形成脑疝，危及患者生命，常需要急诊手术行脑内血肿清除[5]。……