前上指向前交通动脉瘤采用翼点入路的侧别选择  

Side selection of the pterional approach for anterosuperior-pointing anterior communicating artery aneurysms

作　　者：张龙[1] 刘保国[1] 漆松涛[2] 张国忠[2] 李伟光[2] 冯文峰[2] 

机构地区：[1]汕头大学医学院附属粤北人民医院神经外科,韶关512026 [2]南方医科大学南方医院神经外科

出　　处：《中国神经精神疾病杂志》2015年第9期558-563,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：韶关市科技计划(医学类)项目(编号:2014CX/K266);韶关市医学科研基金(编号:Y14048)

摘　　要：目的对比评价前上指向前交通动脉瘤采用A2平面开放侧与闭合侧翼点入路治疗的手术难度、安全性与疗效,指导翼点入路的侧别选择。方法回顾性分析42例采用手术夹闭的前上指向前交通动脉瘤患者的临床资料和影像学资料,分为A2平面开放侧翼点入路组22例及A2平面闭合侧翼点入路组(对照组)20例。对比分析两组的直回切除率,同侧A2移位率,手术并发症发生率,夹闭效果,术后6个月认知障碍发生率和格拉斯哥预后评分(Glasgow Outcome Scale,GOS)等。结果直回切除及同侧A2移位率A2平面开放侧翼点入路组(4/22)较对照组(11/20)低(χ2=6.185,P<0.05),术后6个月认知障碍发生率A2平面开放侧翼点入路组(4/22)较对照组(10/20)低(χ2=4.773,P<0.05),手术并发症发生率A2平面开放侧翼点入路组(1/22)也较对照组(7/20)低(χ2=4.481,P<0.05)。术后夹闭效果和术后6个月GOS等两组间比较均无明显统计学意义(P>0.05)。结论前上指向前交通动脉瘤采用A2平面开放侧翼点入路可降低手术难度、利于瘤颈保护和预防手术并发症。ObjectiveTo investigate the difficulty, safety and clinical efficacy of the pterional approach from the side of open A2 plane vs the approach from the side of closed A2 plane for anterosuperior-pointing anterior communicating artery aneurysms（ACo AA）.MethodsForty-two patients with anterosuperior-pointing ACo AA treated by microsurgical clipping were divided into two groups of the approach from the side of open A2 plane（n=22） and the approach from the side of closed A2 plane（n=20）. Primary objective endpoints were rates of gyrus rectus aspiration, displacement of the ipsilateral A2 and surgical-related complications, clipping results, incidence of cognitive function impairment and Glasgow Outcome Scale（GOS） at 6 months after treatment.ResultsThe incidence of gyrus rectus aspiration and displacement of the ipsilateral A2, cognitive impairment at 6 months after treatment and the surgical-related complications was also significant lower in the approach from the side of open A2 plane than in the approach from the side of closed A2 plane [4（18.2%） cases vs. 11（55.0%） cases, χ2=6.185, P〈0.05; 4（18.2%） cases vs. 10（50.0%） cases, χ2=4.773, P〈0.05; 1（4.5%） case vs. 7（35.0%） cases, χ2=4.481 P〈0.05]. There were no significant differences in postoperative clipping results and GOS at 6 months after treatment between two approaches（P〈0.05）.ConclusionsThe pterional approach from theside of open A2 plane in patients with anterosuperior-pointing ACo AA allows the aneurysmal necks to be secured safely,decreases operation difficulty and prevents surgical-related complications.

关 键 词：前交通动脉 动脉瘤 指向 A2平面 夹闭 

分 类 号：R651.12[医药卫生—外科学]