大脑中动脉动脉瘤的显微手术治疗  

Microsurgical treatment of middle cerebral artery aneurysm

作　　者：李卫东[1] 卞留贯[2] 孙青芳[2] 李云峰[2] 沈建康[2] 

机构地区：[1]安徽省芜湖市第一人民医院神经外科,芜湖市241000 [2]上海交通大学医学院附属瑞金医院神经外科

出　　处：《立体定向和功能性神经外科杂志》2013年第3期152-156,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨大脑中动脉(MCA)动脉瘤的显微手术策略及影响预后的相关因素。方法回顾分析手术夹闭的112例MCA动脉瘤,其中出血72例,动脉瘤位于MCA近端19例(上壁型10例、下壁型9例)、分叉部76例(前上、后方及下型分别为28、32、12例)、远端5例、多发MCA动脉瘤12例,常规翼点经侧裂入路。结果成功夹闭109例,术后GOS 5分85例、4分5例、3分13例、2分4例,死亡5例,手术相关的脑缺血损伤11例(近端4例、分叉部5例、远端2例,他们之间有显著性差异,χ2=6.14,P<0.05),患者的预后与有无血肿、术前Hunt-Hess分级有关(χ2分别为4.15和3.98,P<0.05)。结论 MCA动脉瘤的手术夹闭效果较好,预后与是否出血、是否伴有血肿等有关。Objective To explore the strategy of microsurgery in middle cerebral artery aneurysm,and the factors of affecting outcome.Methods To retrospectively analyze the 112cases with MCA aneurysm by microsurgical clipping.Among of these cases,72cases were bleeding.There were 19cases with aneurysm in proximity of MCA（aneurysm located in superior wall 10 cases,inferior wall 9cases）,76cases in bifurcation of MCA（aneurysm direction to anterior-superior in 28cases,posterior in 32cases and inferior in 12cases）,5cases in the distal of MCA.And 12cases were multiple MCA aneurysms.All the operation was underwent by pterional transsylvian approach.Results 109cases with MCA aneurysm were successful clipped.According to Glasgow Outcome Scale,there were 85cases with GOS 5,5cases with GOS 4,13cases with GOS 3 and 4cases with GOS 2,and 5cases were dead.The prognosis was associated with whether the hematoma or not and the severity of SAH（χ2=4.15,χ2=3.98,P0.05respectively）.On the other hand,there were 11cases with surgical associated cerebral ischemia,including 4cases in proximity segment,5cases in bifurcation and 2cases in distal of MCA（χ2=6.14,P0.05）.Conclusion Surgical clipping of MCA aneurysm has a good outcome.And the prognosis is associated with whether hemorrhage and hematoma or not.

关 键 词：大脑中动脉 动脉瘤 显微手术 预后 

分 类 号：R739.4[医药卫生—肿瘤]