摘要目的 探讨应用复合手术治疗颅内复杂血管疾病的安全性及有效性.方法 回顾性分析2014年12月至2015年10月南方医科大学南方医院神经外科行复合手术治疗的16例颅内复杂血管疾病患者,其中急性动脉瘤性蛛网膜下腔出血6例,复发动脉瘤术中栓塞出血1例,未破裂动脉瘤5例,自发性脑出血4例.6例动脉瘤行颅内外动脉搭桥并动脉瘤血管内旷置或孤立术,6例动脉瘤行塑形夹闭术,4例自发性脑出血行血肿清除并血管畸形切除术.随访时间为3～7个月.结果 6例行颅内外搭桥的患者术中吻合血管均通畅.6例行动脉瘤塑形夹闭的患者均夹闭完全.4例血管畸形患者中,3例血管畸形完全切除,1例血管畸形术中造影提示有少量残余,再次切除后达到完全切除.术后1例因严重血管痉挛放弃治疗.1例术后出现灌注压突破,术后遗留右上肢肌力障碍.15例患者行临床随访,均无新发神经功能障碍,格拉斯哥预后分级(GOS)Ⅴ级8例,Ⅳ级6例,Ⅲ级1例.5例行DSA随访,3例血管搭桥患者其动脉瘤无复发,载瘤动脉及吻合血管通畅;2例血管畸形患者血管畸形无残余.结论 应用复合手术方式治疗颅内复杂血管疾病,可提高治疗精确性,并且安全、有效.

abstractsObjective To investigate the safety and short-term effectiveness of using the hybrid operation in the treatment of complex cerebrovascular diseases.Methods Sixteen patients with complex cerebrovascular diseases treated with hybrid operation at the Department of Neurosurgery,Nanfang Hospital,Southern Medical University from December 2014 to October 2015 were analyzed retrospectively,including 6 patients with acute aneurysmal subarachnoid hemorrhage,1 with intraoperative embolism bleeding of recurrent aneurysm,5 with unruptured aneurysm,and 4 with spontaneous intracerebral hemorrhage.Six patients were treated with extra-intracranial arterial bypass and aneurysm exclusion or trapping,6 with intracranial aneurysm were treated with shaping clipping,4 with spontaneous intracerebral hemorrhage were treated with hematoma removal and vascular malformation resection.The follow-up time was 3 to 7 months.Results In 6 patients treated with extra-intracranial arterial bypass,the intraoperative anastomotic vessels were patent.Six patients treated with aneurysm shaping clipping were clipped completely.Of the 4 patients with vasc ular malformation,the vascular malformations of 3 cases were resected completely,the vascular malformation of 1 case had a small amount of residual,and a complete resection was achieved after resection again.After procedure,1 patient gave up treatment because of severe vascular spasm.One patient had a perfusion pressure breakthrough after operation,and he left right upper limb muscle disorder after procedure.Fifteen patients were followed up in clinical practice,they did not have any new neurological disorders,the Glasgow Outcome Scale (GOS) Ⅴ in 8 cases,Ⅳ in 6 cases,and Ⅲ in 1 case.Five patients were followed up with DSA;the aneurysms of 3 cases treated with vascular bypass did not have recurrence,and the parent arteries and anastomosed vessels were patent.The vascular malformation did not have residual in 2 patients with vascular malformation.Conclusion The treatment of complicated intracranial vascular diseases with hybrid operation may improve the accuracy of treatment,and it is both safe and effective.