颅内后循环高分级动脉瘤的手术治疗和预后分析  

Surgical treatment and clinical outcome of patients with intracranial posterior circulation poorgrade aneurysms

作　　者：郑匡[1] 钟鸣[1] 谭显西[1] 李则群[1] 熊叶[1] 

机构地区：[1]温州医学院附属第一医院神经外科,325000

出　　处：《中国医师进修杂志》2016年第5期385-389,共5页Chinese Journal of Postgraduates of Medicine

基　　金：温州市科技计划项目（Y20150211）

摘　　要：目的探讨颅内后循环高分级动脉瘤的手术治疗效果和预后分析。方法收集2010年10月至2012年3月35例颅内后循环高分级动脉瘤患者，世界神经外科学会联合会（WFNS）分级Ⅳ级17例，Ⅴ级18例。29例患者行动脉瘤手术治疗，其中栓塞治疗27例，夹闭治疗2例；4例单纯行脑室外引流术；2例药物保守治疗。出院时进行神经功能评分，并在术后1、12个月进行随访，神经功能预后评价采用格拉斯哥预后量表（GOS）评分。结果单纯行脑室外引流术或药物保守治疗的6例患者，5例在住院期间死亡，1例随访至出院后12个月，恢复良好。29例行动脉瘤手术患者，出院时恢复良好15例（51．7％），恢复差9例（31．0％），死亡5例（17．2％）。术后1个月随访恢复良好14例（48．3％），恢复差9例（31．0％），死亡6例（20．7％）。术后12个月随访恢复良好18例（62．1％），恢复差5例（17．2％），死亡6例（20．7％）。结论高分级后循环动脉瘤患者经积极手术治疗，患者预后较好。Objective To investigate the surgical treatment and clinical outcome of patients with intracranial posterior circulation poor-grade aneurysms. Methods The clinical data of 35 patients with intraeranial posterior circulation poor-grade aneurysms were collected. Seventeen patients were World Federation of Neurosurgical Societies （WFNS） grade IV and 18 patients were WFNS grade V. Twenty-nine patients were definitively treated with open microsurgery treatment（2 patients） and endovascular treatment （27 patients）. Six patients received conservative treatment, including 4 patients only receiving external ventricular drainage to decrease intracranial pressure and 2 patients only receiving medical treatment. The nerve function were evaluated by Glasgow outcome scale （GOS） at discharge from hospital and 1 and 12 months after operation. Results In the patients who received conservative treatment, 5 patients were dead in hospital, and 1 patient got good outcome after 12 months. In the patients who received surgical treatment, at discharge from hospital good outcome were achieved in 15 patients （51.7%）, poor outcome in 9 patients （31.0%）, and death happened in 5 patients （17.2%）. At 1 month after operation, good outcomes were achieved in 14 patients （48.3%）, poor outcome in 9 patients （31.0%）, and death happened in 6 patients （20.7%）. At 12 months after operation, goodoutcome were achieved in 18 patients （62.1%）, poor outcome in 5 patients （17.2%）, and death happened in 6 patients （20.7%）. Conclusions Patients with posterior circulation poor-grade aneurysms have better prognosis after positive surgical treatment.

关 键 词：颅内动脉瘤 外科手术 预后 

分 类 号：R651.12[医药卫生—外科学]