本文選題：前交通動脈 + 穿通支　； 參考：《天津醫(yī)科大學(xué)》2007年碩士論文

【摘要】： 目的：通過在手術(shù)顯微鏡下對前交通動脈和其穿通支血管的顯微解剖與測量，為神經(jīng)外科提供該區(qū)域的解剖學(xué)資料。同時總結(jié)309例前交通動脈瘤患者的臨床資料，從開顱手術(shù)和血管內(nèi)栓塞兩種治療途徑展開討論，分析預(yù)后，以提高前交通動脈瘤的診治水平。 方法：一、應(yīng)用手術(shù)顯微鏡對10具成人尸頭標(biāo)本的ACoA及其所屬穿通支血管進(jìn)行顯微解剖與測量，描述其毗鄰關(guān)系、供血范圍及各種變異，獲取重要的解剖學(xué)參數(shù)，以指導(dǎo)臨床和手術(shù)操作。 二、回顧性分析天津市環(huán)湖醫(yī)院自2002年1月—2007年1月收治的309例前交通動脈瘤患者的臨床資料，并對影像學(xué)診斷，治療方法、時機的選擇，并發(fā)癥的防治等問題加以總結(jié)。 結(jié)果：一、ACoA及其所屬穿通支血管的顯微解剖學(xué)研究顯示，本組10例尸頭標(biāo)本共見10支ACoA，，其中雙側(cè)A1段遠(yuǎn)端融合導(dǎo)致ACoA缺如的有1例(10％)，單一通道連接雙側(cè)ACA的簡單型ACoA有8例(80％)，雙支型ACoA者1例(10％)。ACoA呈左右走向者8例(80％)，前后走向者2例(20％)。ACoA高于視交叉上面者9例(90％)，貼于視交叉上面者1例(10％)。ACoA中點位于視交叉中部水平者8例(80％)，位于視交叉后緣水平者2例(20％)。ACoA偏左者4例(40％)，居中者6例(60％)。所有ACoA均有穿通支血管發(fā)出，這些小穿支多起于ACoA的后壁、上壁及下壁，但未發(fā)現(xiàn)自ACoA的前壁發(fā)出者。有胼胝體中央動脈存在者3例(30％)。 二、臨床資料統(tǒng)計顯示，本組前交通動脈瘤患者為309例，占同期顱內(nèi)動脈瘤患者的29.58％，其中118例行顯微手術(shù)治療，預(yù)后良好95例(GOS分級Ⅳ—Ⅴ級)，預(yù)后差17例(GOS分級Ⅱ—Ⅲ級)，死亡6例(GOS分級Ⅰ級)；181例行血管內(nèi)栓塞治療，預(yù)后良好148例，預(yù)后差24例，死亡9例；10例患者因經(jīng)濟(jì)條件差行保守治療或放棄治療。 結(jié)論：通過對ACoA及其穿通支血管的顯微解剖研究，證實ACoA存在解剖學(xué)變異，其穿通支血管供血范圍重要。而ACoA又是顱內(nèi)動脈瘤的好發(fā)部位，在手術(shù)中如果損傷這些血管，常常會造成嚴(yán)重的并發(fā)癥。故充分了解該部位血管的顯微解剖與形態(tài)學(xué)變異，合理地選擇手術(shù)時機和治療途徑，積極地預(yù)防和控制并發(fā)癥，是提高前交通動脈瘤治療效果的關(guān)鍵。
[Abstract]:Objective: to provide anatomical data of anterior communicating artery and its perforating branch for neurosurgery by microanatomy and measurement under surgical microscope. At the same time, the clinical data of 309 patients with anterior communicating aneurysm were summarized, and the treatment methods of craniotomy and endovascular embolization were discussed, and the prognosis was analyzed in order to improve the diagnosis and treatment of anterior communicating aneurysm. Methods: first, the microanatomy and measurement of ACoA and its perforating vessels in 10 adult cadaveric head specimens were carried out by using surgical microscope. The adjacent relationship, blood supply range and various variations were described, and important anatomical parameters were obtained. To guide clinical and surgical procedures. Secondly, the clinical data of 309 patients with anterior communicating artery aneurysm admitted from January 2002 to January 2007 in Tianjin Huanhu Hospital were analyzed retrospectively. The imaging diagnosis, treatment method, timing of treatment, prevention and treatment of complications were summarized. Results: the microanatomical study of ACoA and its perforating branch showed that, There were 10 branches of ACoA in 10 cadaveric head specimens, of which 1 case (10%) was absent due to bilateral A1 segment distal fusion, 8 cases (80%) were simple ACoA with single channel connecting bilateral ACA, and 1 case (10%) of double branch ACoA. ACoA showed a left or right trend. 8 cases (80%), 2 cases (20%). ACoA was higher than 9 cases (90%) above the optic chiasma, 1 case (10%) attached to the optic chiasma. 8 cases (80%) had the middle point of ACoA at the level of the middle of the optic chiasma, 2 cases were at the posterior edge of the optic chiasma. Cases (20%). ACoA was left in 4 cases (40%) and median in 6 cases (60%). Perforating branches were found in all ACoA. These perforators originated from the posterior wall, superior wall and inferior wall of ACoA, but not from the anterior wall of ACoA. There were 3 cases (30%) with central artery of corpus callosum. Second, clinical data showed that 309 patients with anterior communicating aneurysms accounted for 29.58 percent of intracranial aneurysms in the same period, of which 118 received microsurgical treatment. The prognosis was good in 95 cases (grade 鈪

本文編號：2075320