Tanaka S, Mori T, Ohara H, Takaku A, Suzuki J
Acta Neurochir (Wien). 1979;48(3-4):223-30. doi: 10.1007/BF02056970.
Among 1,000 cases of patients undergoing direct surgery on cerebral aneurysms, two, showed clear signs of preoperative, and 19 cases showed postoperative gastrointestinal bleeding. We have made a clinical analysis of various aspects of the 19 cases in which the bleeding developed postoperatively. 1. Gastrointestinal bleeding was most frequent postoperatively in cases of AComA aneurysms (4.3%) and ICA aneurysms (2.0%), and less common in MCA and ACA aneurysm cases. 2. Gastrointestinal bleeding was most frequently seen in those cases operated on between the third and seventh days after the last subarachnoid haemorrhage (8.9%) and was more common in cases with a relatively poor preoperative grade. 3. The development of such bleeding in cases with a good preoperative grade was due to problems with the surgical operation in most cases, although the influence of vasospasm must not be ignored. The development of bleeding in cases with a poor preoperative grade is thought to be due primarily to vasospasm and transitory brain damage to the hypothalamus and the orbital portion of the anterior lobe due to a haematoma caused by aneurysm rupture. 4. First, the location of gastrointestinal bleeding should be determined endoscopically and, if haemostasis is not achieved by coagulation, then the desirability of surgery should be considered early. Abdominal surgery may be performed.
在1000例接受脑动脉瘤直接手术的患者中，有2例术前出现明显症状，19例术后出现胃肠道出血。我们对术后发生出血的19例患者的各个方面进行了临床分析。1. 前交通动脉瘤（4.3%）和颈内动脉瘤（2.0%）患者术后胃肠道出血最为常见，大脑中动脉和大脑前动脉动脉瘤患者则较少见。2. 蛛网膜下腔最后一次出血后第3至7天接受手术的患者中，胃肠道出血最为常见（8.9%），术前分级相对较差的患者中更为常见。3. 术前分级良好的患者发生此类出血，在大多数情况下是由于手术操作问题，尽管血管痉挛的影响也不容忽视。术前分级较差的患者发生出血，主要被认为是由于血管痉挛以及动脉瘤破裂导致的血肿对下丘脑和额叶眶部造成的短暂性脑损伤。4. 首先，应通过内镜确定胃肠道出血的位置，如果通过凝血无法止血，则应尽早考虑手术的必要性。可进行腹部手术。
