Tanaka S, Mori T, Ohara H, Takaku A, Suzuki J
No Shinkei Geka. 1979 Oct;7(10):977-81.
Among the 1,000 cases of direct surgery on cerebral aneurysms, two cases showed clear signs of preoperative and 19 cases showed postoperative gastrointestinal bleeding. Here 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 VBA aneurysms (4.3%) and AcomA aneurysms (2.9%) 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 from the last hemorrhage attack (9.0%) and was more common in those 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 hematoma caused by aneurysm rupture. (4) First the location of gastrointestinal bleeding should be determined endoscopically and, if hemostasis is not possible even after attempted coagulation, then the desirability of surgery should be determined in an early period and abdominal surgery performed.
在1000例脑动脉瘤直接手术病例中，2例术前有明确出血迹象，19例术后出现胃肠道出血。在此，我们对术后发生出血的19例病例的各个方面进行了临床分析。（1）椎动脉-基底动脉（VBA）动脉瘤病例（4.3%）和前交通动脉（AcomA）动脉瘤病例（2.9%）术后胃肠道出血最为常见，而大脑中动脉（MCA）和大脑前动脉（ACA）动脉瘤病例则较少见。（2）胃肠道出血最常出现在末次出血发作后第3天至第7天接受手术的病例中（9.0%），且在术前分级相对较差的病例中更为常见。（3）术前分级良好的病例发生此类出血，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。术前分级较差的病例发生出血，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部位，如果即使尝试凝血后仍无法止血，那么应尽早确定是否进行手术，并实施腹部手术。
