顱內動脈瘤夾閉術后殘留和復發的處理

【中圖分類號】 R743 【文獻標志碼】 A 【文章編號】1672-7770（2025）02-0126-05

Abstract： Objective To explore the characteristics of residual and recurrent intracranial aneurysms after clipping，as well as the difficulties and efficacy of re-treatment. MethodsA total of 15 patients with intracranial residual and recurrent aneurysms after clipping admitted to Department of Neurosurgery， Leshan Geriatric Hospital from January 2014 to January 2024 were retrospectively analyzed and the relevant literature were reviewed. ResultsAt the first postoperative follow-up，7 cases were found to be completely clipped and 8 cases showed small remnants. The shortest time from aneurysm clipping to recurrence was 1 month， and the longest was 20 years with an average of 50.5 months. The reasons for the retreatment of aneurysms included the recurrence and enlargement of aneurysms after complete clipping， as well as the progressive enlargement of residual aneurysms. Re-clipping was performed in 10 cases of recurrent aneurysms， 2 of them suffred postoperative cerebral infarction. The remaining 5 patients with endovascular embolization recovered well. Conclusions The residual aneurysms have a higher risk of regrowth and rupture. As a result， they should be followed closely and regularly. Interventional embolization is a safe and efective treatment for recurrent aneurysms after clipping. For cases unsuitable for interventional embolization， surgical treatment needs to overcome the technical diffculties of reoperation and master various skills of vascular surgery.

Key words： intracranial aneurysm； operative technique； recurrent aneurysm； residual aneurysm雖然血管內治療在顱內動脈瘤的治療中占有越來越大的比例，但動脈瘤夾閉手術仍然在動脈瘤治療中具有重要的作用[1]。作為顱內動脈瘤治療的經典手術方式，夾閉術具有更好的穩定性和更低的復發率[2]。顱內動脈瘤治療的目的是將動脈瘤排除于正常循環以外，并保持載瘤動脈以及穿支血管的通暢性，而手術夾閉是實現這一目標的有效選擇[2]。動脈瘤夾閉術后復發仍然是一個重要的問題，完全夾閉后動脈瘤的復發率很難確定，但據報道每年約為 。迄今為止，對于夾閉術后復發動脈瘤的治療包括再次手術夾閉、血管內介入栓塞以及聯合手術等處理方式[6-8]。再次手術夾閉復發動脈瘤是動脈瘤手術中最困難的步驟之一，這種手術不僅由于手術部位粘連等問題在技術上很困難，而且在決策方面也很困難[9]。因為技術上的困難，血管內介入栓塞治療復發動脈瘤被認為是一種安全有效的治療方式[10-11]。由于夾閉術后復發的動脈瘤相對少見，目前的報道還沒有詳細討論過更適合復發動脈瘤的治療方法。本研究回顧性分析2014年1月一2024年1月四川大學華西醫院收集的15例開顱夾閉術后復發動脈瘤患者的臨床資料，總結其臨床及影像學特征及手術治療的情況，旨在對該類動脈瘤的處理提供指導及幫助。

1資料與方法

1.1一般資料共納入15例顱內動脈瘤夾閉術后復發的患者（5例患者第一次在外院手術），其中男5例，女10例；……