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目的探讨老年人颞叶血肿起病动脉瘤的诊断与治疗。方法收集以颞叶血肿起病的经手术证实为动脉瘤的16例老年患者临床资料,术前H&H分级Ⅲ级10例、Ⅳ级4例、Ⅴ级2例。有3例患者术前行CT血管造影检查。所有患者均采用扩大翼点显微动脉瘤夹闭术,术中证实后交通动脉瘤9例,大脑中动脉瘤7例。出院后随访3~12个月,以格拉斯哥昏迷评分评定疗效。结果 16例患者均成功夹闭动脉瘤。术前H&H分级Ⅲ级的10例患者中,术后恢复良好6例,轻度伤残3例,严重伤残1例;4例Ⅳ级患者中,术后轻度伤残3例,严重伤残1例;2例Ⅴ级患者中,严重伤残1例,植物状态1例。结论以颞叶血肿起病动脉瘤多为后交通动脉瘤及大脑中动脉瘤,术前充分了解病情并行CT血管造影检查、术中彻底探查是提高疗效和预后的主要方法。
Objective To investigate the diagnosis and treatment of the aneurysm of the temporal lobe hematoma in the elderly. Methods The clinical data of 16 elderly patients with aneurysm confirmed as surgically diagnosed by temporal lobe hematoma were collected. There were 10 cases of grade Ⅲ H / H, 4 cases of grade Ⅳ and 2 cases of grade Ⅴ. Three patients underwent preoperative CT angiography. All patients were treated with enlarged wing point aneurysm clipping, 9 cases of posterior communicating aneurysm and 7 cases of middle cerebral artery aneurysm were confirmed during operation. Follow-up after discharge from 3 to 12 months to assess the efficacy of Glasgow coma score. Results All 16 patients successfully closed the aneurysm. Among 10 patients with preoperative H & H grade Ⅲ, 6 were well recovered, 3 were mild disability, and 1 was severe disability. Among the 4 patients with grade Ⅳ, 3 were mild disability after operation and 3 were severe injury 1 case of residual; 2 cases of grade V patients, 1 case of severe disability and 1 case of plant state. Conclusion Most of the aneurysms with temporal lobe hematoma are posterior communicating aneurysms and middle cerebral artery aneurysms. Before operation, they can fully understand the condition of CT angiography. The thorough exploration during operation is the main method to improve curative effect and prognosis.