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目的总结电解可脱卸弹簧圈(GDC)栓塞治疗颅内动脉瘤的临床经验。方法 21例颅内动脉瘤(23个)患者中17例为破裂动脉瘤。接Hunt-Hess分级I级2例,Ⅱ级1例,Ⅲ级6倒,Ⅳ级10倒,V级2例。16例行急诊栓塞,术后腰椎蛛网膜下腔持续引流,并予以3h治疗。结果动脉瘤完全闭塞20个,闭塞达90%以上2个。闭塞在90%以下1个。全组手术死亡1例。随访1～30个月。1例术后2周死于中枢衰竭及肺部感染;1例术后1.5月复发出血,经手术夹闭痊愈;1例有轻度神经功能缺失症状,其余恢复良好。结论 GDC栓塞颅内动脉瘤安全、可靠,以致密填塞动脉瘤疗效为佳,破裂动脉瘤急诊栓塞治疗。术后腰椎蛛网膜下腔持续引流可明显提高疗效。
Objective To summarize the clinical experience of treatment of intracranial aneurysms with electrolytic detachable coil (GDC) embolization. Methods Twenty-one of 21 patients with intracranial aneurysms (23) were ruptured aneurysms. Hunt-Hess graded I grade in 2 cases, Ⅱ grade in 1 case, Ⅲ grade 6 down, Ⅳ grade 10 down, V grade in 2 cases. 16 cases of emergency embolization, continuous lumbar subarachnoid drainage, and to 3h treatment. Results aneurysm completely occluded 20, occlusion of more than 90% 2. Occlusion in less than 90% 1. The whole group died of surgery in 1 case. Followed up for 1 to 30 months. One patient died of central failure and pulmonary infection 2 weeks after operation. One patient had recurrent hemorrhage 1.5 months after operation and was cured by surgical clipping. One patient had mild neurological deficit and the others recovered well. Conclusions GDC embolization of intracranial aneurysms is safe and reliable, and the efficacy of densely packed aneurysms is better. Emergency embolization of ruptured aneurysms is effective. Postoperative lumbar subarachnoid continuous drainage can significantly improve the efficacy.