摘要目的 探讨急诊手术治疗大脑中动脉(MCA)动脉瘤破裂伴脑内血肿的经验及预后.方法 回顾性分析2009年1月至2014年5月河南省人民医院神经外科急诊手术治疗的MCA动脉瘤破裂伴脑内血肿患者的临床资料及随访结果,共23例.结果 23例患者均在发病24h内急诊行开颅血肿清除及动脉瘤夹闭术,其中16例行去骨瓣减压,1例术后3d因严重脑水肿再次行去骨瓣减压术.术后1周复查CTA示动脉瘤无残留.5例并发脑梗死,2例术后因出现交通性脑积水行脑室-腹腔分流术.术后对患者行2～ 25个月随访,格拉斯哥预后评级(GOS)恢复良好(Ⅴ级)6例,生活自理(Ⅳ级)9例,重度残疾(Ⅲ级)4例,植物生存(Ⅱ级)2例,死亡(Ⅰ级)2例.预后良好率为65.2％ (15/23),病死率为8.7％ (2/23).结论 急诊显微手术治疗MCA动脉瘤破裂合并脑内血肿,可以获得较满意的预后.

abstractsObjective To investigate the experience and prognosis of emergency microsurgery for the treatment of ruptured middle cerebral artery (MCA) aneurysms with intracerebral hematoma.Methods The case data and follow-up results of 23 patients with ruptured MCA aneurysms with intracerebral hematoma treated with emergency operation at the Department of Neurosurgery,Henan Provincial People(s) Hospital from January 2009 to May 2014 were analyzed retrospectively.Results All 23 patients underwent emergency microsurgery for hematoma evacuation and aneurysm clipping within 24 hours after symptom onset,and 16 were treated with decompressive craniectomy.One patient had serious cerebral edema at day 3 after procedure,and he was treated with decompressive craniectomy once more.CTA revealed that 1 week after procedure,no residual aneurysm was observed.Five patients complicated with cerebral infarction.Two patients were treated with ventriculoperitoneal shunt after procedure because of having communicating hydrocephalus.The patients were followed up for 2-25 months after procedure.The Glasgow outcome scale (GOS) showed that 6 patients had good recovery,9 could take care of themselves,4 had severe disability,2 were in a persistent vegetative state,and 2 died.The good prognosis rate was 65.2％ (15/23) and the mortality rate was 8.7％ (2/23).Conclusion Emergency microsurgery for the treatment of ruptured MCA aneurysms with intracerebral hematoma can achieve satisfactory prognosis.