后交通动脉瘤介入栓塞与手术夹闭治疗分析

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1、授予单位代码10089学号或申请号20153269中国图书分类号R651.1+2HebeiMedicalUniversity硕士学位论文专业学位后交通动脉瘤介入栓塞与手术夹闭治疗分析研究生：甄朝健导师：胡福广教授专业：外科学二级学院：河北医科大学第二医院2018年3月目录中文摘要··········································································1英文摘要···························································

2、···············2英文缩写··········································································3综述后交通动脉瘤介入栓塞与手术夹闭治疗分析·················4致谢···············································································21个人简历·························································

3、················22中文摘要后交通动脉瘤介入栓塞与手术夹闭治疗分析摘要后交通动脉瘤是最常见的动脉瘤之一。后交通动脉瘤的解剖变异包括后交通动脉的大小和动脉瘤颈部不同程度的受累。在这些动脉瘤的开颅夹闭过程中，磨除前床突、临时阻断、腺苷至心脏停搏技术和术中脑血管造影都是良好的辅助手段。介入栓塞也是一种行之有效的治疗方法，特别是在老年患者中。然而，后交通动脉瘤的复发率特别高，须密切追踪随访。针对宽颈后交通动脉瘤、真性后交通动脉瘤和胚胎型后交通动脉相关的动脉瘤，开颅夹闭对动脉瘤的完全闭塞和保留后交通动脉可能有较好的效果。然而随着介入栓塞技术的进

4、步，介入栓塞治疗后交通动脉瘤在不久的将来可能会是更好的选择。后交通动脉瘤患者中1/5合并动眼神经麻痹伴或不伴蛛网膜下腔出血。治疗时间窗、部分性动眼神经麻痹都与动眼神经功能恢复相关。开颅夹闭与介入栓塞治疗都为患者的康复提供了机会。根据二级证据，从使患者更好的恢复考虑，开颅夹闭似乎是更好的选择，然而介入栓塞治疗也是另外一种选择，特别是对于合并一些其他疾病的老年患者。关键词:颅内动脉瘤,蛛网膜下腔出血,后交通动脉,介入栓塞,手术夹闭,动眼神经麻痹1英文摘要AnalysisofCoilembolizationandsurgicalclippingofpost

5、eriorcommunicatingarteryaneurysmsABSTRACTPosteriorcommunicatingarteryaneurysmsareoneofthemostcommonaneurysms.TheanatomicvariationoftheaneurysmsincludesthesizeofPComAandtheneckinvolvementoftheaneurysm.Duringsurgicalclippingoftheseaneurysms,anteriorclinoidectomy,temporaryocclusio

6、n,adenosinetocardiacarrestandintraoperativecerebrovascularangiographyaregoodauxiliarymethods.Interventionalembolizationisalsoaneffectivetreatment,especiallyinelderlypatients.However,therecurrencerateofcoiledposteriorcommunicatingarteryaneurysmsisveryhighandshouldbefollowedclose

7、ly.Forwide-neckedPComAaneurysms,truePComAaneurysmsandaneurysmsassociatedwithafetalPcomA，craniotomymayhaveagoodeffectonthecompleteocclusionofaneurysmsandpreservationofPComA.However,withtheprogressofinterventionalembolization,interventionalembolizationmaybeabetterchoiceforthetrea

8、tmentofPComAaneurysmsinthenearfuture.1/5patientswithPC