前交通动脉瘤158例疗效评价与手术技巧探讨  

Analysis on the efficacy and surgical techniques of anterior communicating aneurysms in 158 cases

作　　者：孟祥靖[1] 汪建军[1] 郭建[1] 崔友强[1] 孔建新[1] 李猛[1] 刘广存[1] 刘树山[1] 

机构地区：[1]山东省千佛山医院神经外科,济南250014

出　　处：《中国综合临床》2011年第7期683-685,共3页Clinical Medicine of China

摘　　要：目的探讨前交通动脉瘤的手术疗效、手术时机与手术技巧。方法回顾性分析158例前交通动脉瘤手术过程与疗效。158例患者中合并其他部位的动脉瘤10例。均发生或曾经发生自发性蛛网膜下腔出血（SAH）（其中5例为非责任前交通动脉瘤），均行眶一翼点入路动脉瘤夹闭术。术前Hunt-Hess分级：I级24例，Ⅱ级45例，Ⅲ级54例，Ⅳ级31例，V级4例。手术时间在出血后3d内者44例，4～14d74例，14d以后40例。结果根据GOS疗效判断标准：恢复良好138例（87．34％），中残9例（5．69％），重残6例（3_．80％），死亡5例（3．16％，包括家属放弃者）。恢复良好的138例中I级动脉瘤24例，Ⅱ级42例，Ⅲ级47例，Ⅳ级25例；其中3d内手术者39例，4-14d64例，14d以后35例。结论前交通动脉瘤的手术时机应依据患者的CT、DSA以及详细的神经系统检查等情况综合分析决定；眶一翼点入路有利于动脉瘤的显露；术前、术中、术后采取降低颅内压、脑保护以及3H治疗等一系列措施，有利于患者的预后。．Objective To explore the efficacy,operation timing and techniques of surgical treatment in patients with the anterior communicating aneurysms. Methods We retrospectively analyzed the surgical procedures and effectiveness of 158 patients with anterior communicating aneurysms. Ten of the 158 cases were combined with aneurysms in other branches. All patients had experienced SAH （5 cases were not relevant to anterior communicating aneurysm） and received incarceration of aneurysms through the orbit-pterion approach. Preoperative Hunt-Hess grade： the number of patients with grade I , Ⅱ,Ⅲ, IV and V were 24,45,54,31 and 4, respectively. Fourty-four cases received surgery within 3 days after SAH,74 cases within 4 to 14 days, and 40 cases after 14 days. Results According to GOS grade：138 cases （87.34%） recovered with good outcome,9 cases （5.69%） with moderate disability,6 cases （3.80%） with severe disability, and 5 death （3. 16%, including cases giving up treatment）. Among the 138 patients having good outcomes,24 were grade I ,42 grade I1,47 grade Ⅲ and 25 grade IV. Thirty-nine cases underwent surgery within 3 days,64 within 3 to 14 days,and 35 after 14 days. Conclusion The surgical timing of anterior communicating aneurysms Should be decided according to comprehensive analysis of CT, DSA, and detailed neurologic examination of the patients. Orbitpterion approach is favorable for exposing aneurysms. A series of actions, such as reducing intracranial pressure, cerebral protection and 3H therapy,will help to improve the prognosis of the patients .

关 键 词：前交通动脉瘤 外科手术 

分 类 号：R651.1[医药卫生—外科学]