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目的总结颅内破裂动脉瘤早期显微手术的临床经验。方法 45例颅内动脉瘤破裂患者均早期(3d内)在全麻下采用显微神经外科技术进行手术治疗。45例共48个动脉瘤,46个动脉瘤行瘤颈夹闭,1个行动脉瘤包裹加固术,1个行动脉瘤孤立术。结果术中动脉瘤破裂9例,7例夹闭瘤颈得到妥善处理,1例行包裹加固术后死亡,1例行孤立术无脑梗死发生。随访1~6个月,恢复良好38例,轻残6例,死亡1例。结论颅内动脉瘤破裂早期显微手术治可有效防止再出血的危险,并有利于脑血管痉挛的防治,术中动脉瘤破裂是造成手术失败、术后伤残和死亡的主要原因。
Objective To summarize the clinical experience of early microsurgery of intracranial ruptured aneurysms. Methods 45 cases of ruptured intracranial aneurysms were treated by microsurgical neurosurgery under general anesthesia early (within 3 days). A total of 48 aneurysms were performed in 45 cases, 46 aneurysms were occluded by tumor neck, 1 was treated by aneurysm wrapping and 1 was isolated by aneurysm. Results Intraoperative aneurysm rupture in 9 cases, 7 cases of nodules closed properly treated, 1 case of paroxysmal consolidation and death, 1 case of orphans without cerebral infarction. Followed up for 1 ~ 6 months, 38 cases recovered well, 6 cases were mild disability, and 1 case died. Conclusion Early microsurgical treatment of intracranial aneurysm rupture can effectively prevent the risk of rebleeding, and is conducive to the prevention and treatment of cerebral vasospasm. Intraoperative aneurysm rupture is the main reason of surgical failure, postoperative disability and death.