颅内动脉瘤栓塞术中及术后出血原因分析

doi:10.3969/j.issn.1672-6731.2020.11.012

摘要/Abstract

摘要：

目的探讨颅内动脉瘤栓塞术中及术后出血原因。方法与结果 选择2015年1月至2017年4月采用血管内介入栓塞术共治疗153例颅内动脉瘤患者，其中影像学RaymondⅠ级者91例（59.48%）、Ⅱ级25例（16.34%）、Ⅲ级37例（24.18%）；宽颈动脉瘤73例（47.71%）；支架辅助栓塞63例（41.18%）。术中出血率为1.31%（2/153），出血原因分别为反复超选后弹簧圈微导管到位时破裂（1例）、支架打开后释放首枚弹簧圈时动脉瘤破裂（1例），2例均死亡；术后出血率为1.31%（2/153），均为RaymondⅢ级栓塞，其中1例因再出血死亡，另1例再出血行血肿清除术联合动脉瘤夹闭术，随访1年病情稳定。结论颅内动脉瘤栓塞术中微导丝或微导管操作不当致动脉瘤壁破裂是术中出血的主要原因，而Raymond分级可能为栓塞术后再出血的影响因素。

关键词: 颅内动脉瘤, 栓塞, 治疗性, 失血, 手术, 手术后出血

Abstract:

Objective To investigate the causes of the hemorrage during and after embolization of cerebral aneurysms. Methods and Results We retrospectively analyzed 153 patients who underwent embolization of cerebral aneurysms from January 2015 to April 2017. Raymond Classification following initial treatment indicated 91 cases (59.48%) were in Raymond grade Ⅰ, 25 cases (16.34%) in Raymond grade Ⅱ, 37 cases (24.18%) in Raymond grade Ⅲ. Wide-necked aneurysms were seen in 73 cases (47.71%). Stent assisted embolization was done in 63 cases (41.18%). Intraoperative bleeding rate was 1.31% (2/153), causes of bleeding were rupture after repeated over-selection of coil micro-catheter in place (one case), rupture of aneurysm when release of the first coil after stent opening (one case) and the 2 cases all died. Postoperative rebleeding rate was 1.31% (2/153), both patients were Raymond grade Ⅲ, one of them died after rebleeding, one with cerebral hematoma clearance and aneurysm clipping, the patient was followed up for one year in a stable condition. Conclusions Rupture of aneurysm wall by improper operation of micro-catheter or micro-guidewire during intracranial aneurysm embolization is the main cause of intraoperative bleeding, and Raymond Classification may be the influencing factor for rebleeding after embolization of cerebral aneurysms.

Key words: Intracranial aneurysm, Embolization, therapeutic, Blood loss, surgical, Postoperative hemorrhage

周雷, 王中, 李吻, 朱巍巍. 颅内动脉瘤栓塞术中及术后出血原因分析[J]. 中国现代神经疾病杂志, 2020, 20(11): 1000-1007.

ZHOU Lei, WANG Zhong, LI Wen, ZHU Wei-wei. Causes of bleeding during and after embolization of cerebral aneurysms[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(11): 1000-1007.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I11/1000

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