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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。
Objective To investigate the causes of rupture during intracranial aneurysm embolization, as well as the diagnosis, treatment and prognosis. Methods The clinical data of 420 patients with intracranial aneurysms receiving endovascular embolization from May 1994 to June 2002 were retrospectively analyzed. Among them, 15 cases underwent aneurysm rupture during operation For example, the coil wearing rupture in 8 cases, 1 case of rupture caused by high pressure injection, 3 cases of unknown reasons), deepen the anesthesia immediately after the diagnosis of cerebral angiography, rapid densification embolism aneurysm given protamine reversal of heparinization , Or intraventricular drainage and intracranial hematoma removal. Results In the 15 patients with ruptured aneurysm, 11 cases were completely recovered after treatment, 1 case was mild disability and 3 cases died. Conclusion Rupture during intracranial aneurysm embolization is a serious complication of intravascular intervention. Rupture is mainly related to the morphology and structure of aneurysm. Lack of clinical experience is also one of the causes of intraoperative rupture. The prognosis depends on the amount of bleeding, the patient’s preoperative condition and prompt and correct treatment.