显微手术治疗Willis环前部颅内动脉瘤585例  

Microsurgical treatment of intracranial aneurysms in anterior Willis loop ： experience in 585 patients

作　　者：张国忠[1] 冯文峰[1] 李伟光[1] 李明洲[1] 王刚[1] 漆松涛[1] 

机构地区：[1]南方医科大学南方医院神经外科,广州510515

出　　处：《中华神经外科杂志》2015年第1期15-18,共4页Chinese Journal of Neurosurgery

基　　金：广东省科技计划（2012B031800136）

摘　　要：目的 探讨Willis环前部颅内动脉瘤的显微手术技巧及治疗策略.方法 回顾性分析南方医科大学南方医院神经外科经显微外科手术治疗的Willis环前部动脉瘤585例（612个）的临床资料.术前Hunt-Hess分级：0级32例,Ⅰ级120例,Ⅱ级218例,Ⅲ级176例,Ⅳ级27例,Ⅴ级12例;影像学均显示为蛛网膜下腔出血.患者均行显微动脉瘤夹闭术;早期手术（发病3d内）107例,亚急性期手术（发病后4-14d）376例,延期手术（发病14d后）102例;采用格拉斯哥预后评分（GOS）评估患者的预后情况,比较不同手术时机患者的预后及病死率.结果 585例612个Willis环前部动脉瘤均成功夹闭.术后GOS评分：1分6例,2分13例,3分28例,4分136例,5分402例.随访412例,恢复良好396例（96.2％）.不同手术时机患者的预后良好率及病死率差异无统计学意义（P=0.262及0.624）.结论 显微动脉瘤夹闭术是治疗Willis环前部颅内动脉瘤的有效方法.Objective To explore the microsurgical techniques and therapeutic strategies of intracranial aneurysms in anterior Willis loop.Methods The clinical data of 585 patients with 612 aneurysms in anterior Willis loop treated by microsurgical clipping in our department were analyzed retrospectively.Before operation,according to Hunt-Hess classification,32 cases were grade 0,120 grade,218 grade Ⅱ,176 grade Ⅲ,27 grade Ⅳ and 12 grade Ⅴ.All the patients presented with subarachnoid hemorrhage.All the patients were underwent aneurysm clipping microsurgically,107 cases within 3 days,376 cases within 4-14 days and 102 cases 14 days after onset.The prognosis of patients were assessed by Glasgow outcome scale score （GOS）.The prognosis and mortality rates were compared among patients treated in different time.Results A total of 612 aneurysms were clipped successfully.The postoperative GOS were 1 in 6 cases,2 in 13 cases,3 in 28 cases,4 in 136 cases and 5 in 402 cases.In 412 patients who were followed-up,396 cases （96.2%） achieved good recovery （GOS 4 or 5）.The prognosis and mortality rates of patients treated in different time showed no significant differences （P =0.262 and 0.624）.Conclusion For patients with aneurysms in anterior Willis loop,favorable outcome should be achieved through microsurgical management.

关 键 词：颅内动脉瘤 WILLIS环 显微外科手术 夹闭 

分 类 号：R651.12[医药卫生—外科学]