颅内动脉瘤外科治疗的临床疗效对比分析  

Compare analysis of clinical the curative effect and research progress for intracranial aneurysms surgical treatment

作　　者：朱成明[1] 姚文华[1] 王贵富[2] 张德明[1] 

机构地区：[1]雅安市人民医院神经外科,四川雅安625000 [2]遵义医学院,贵州遵义563003

出　　处：《四川医学》2012年第8期1400-1403,共4页Sichuan Medical Journal

摘　　要：目的探讨颅内动脉瘤复发的临床影响因素及处理原则和并发症的防治措施。方法回顾性分析69例脑动脉瘤手术患者,其中综合加固夹闭手术36例为A组,常规夹闭手术33例为B组,分析手术经过、手术时机、脑血管痉挛的防治与治疗效果、预后及复发的关系。结果脑脊液恢复正常的时间、术中将动脉瘤颈完全夹闭的比率、术后脑积水发生情况比较,差异有统计学意义;术后脑梗死发生率比较,差异无统计学意义。对患者进行6～36个月的随访,6个月近期疗效GOS评分、24个月远期疗效日常生活能力(barthel index)评分、36个月动脉瘤的复发情况差异有统计学意义。结论颅内动脉瘤治疗后再复发的主要原因为:夹闭不全和血流动力学影响。综合加固夹闭手术与病因治疗,能有效减少并发症的发生和预防动脉瘤复发,从而提高治疗效果。Objective To explore the related clinical factors and the management of recurrent intracranial aneurysms,the complication about prevent and treatment of was it. Methods The patients were divided into 2 groups according to the way of sur- gery. in the synthesize and reinforce a clipped operation group A （ n = 36） and in the conventional operation group B （ n = 33）, Through the operative procedure and the operation time point,the prevent and treatment of cerebral vasospasm were analyzed that the trentment effective and have a relapse or the relation to the prognosis of patients intracranial aneurysms. Results There were statistically signficent differences in post-operative cerebrospinal fluid recover to normalcy of time, post-operative Hydrocephalus rate or rate of complete occlusion of the ruptured aneurysm between two groups. The therapeutic effect of group A is better than that of group B either within six or twenty four months after operation according to ADL （ Activities of dialy living,barthel index） and GOS （ Glasgow Outcome Scale） respectively（P 〈 0. 05 ） of these patients were also evaluated by 6 ~ 36 months follow-up after opera- tion. There were no significant statistical differences between tile 2 groups cerebral infarction rate, Tile recurrent of intraeranial aneu- rysms of group A and B after operation in thirty six months did show significant statistical difference （P 〈 0. 05 ）. Conclusion The recurrent of intraeranial aneurysms is due to incomplete clipping and blood flow influence, through synthesize and reinforce clipped as well as tile prevent cause of disease can effective lower occurrence of complication and current of intracranial aneurysms there fore improtte the efficacy of the therapeutic operations.

关 键 词：颅内动脉瘤 夹闭 疗效 动脉瘤复发 预后 

分 类 号：R651.12[医药卫生—外科学]