颅内动脉瘤显微外科手术时机与患者近期及远期预后的关系  

Influencing factors for operation timing and prognosis in patients with intracranial aneurysms

作　　者：梁华新[1] 徐熙鹏[1] 刘乃杰[1] 李东原[1] 郝铮[1] 赵丛海[1] 孙利波[1] 

机构地区：[1]吉林大学中日联谊医院神经外一科,长春130033

出　　处：《中华实验外科杂志》2017年第1期130-133,共4页Chinese Journal of Experimental Surgery

摘　　要：目的探讨颅内动脉瘤显微外科手术时机与患者近期及远期预后的关系。方法分析经显微外科手术治疗的654例颅内动脉瘤患者的临床资料及随访结果。结果654例患者中，早期手术组288例，出院时预后良好者231例（80.02%）；间期手术组81例，出院时预后良好者54例（66.67%）；晚期手术组285例，出院时预后良好者253例（88.77%）；在术后随访到的415例患者中，早期手术组192例，预后良好者153例（79.69%）；间期手术组44例，预后良好者27例（61.36%）；晚期手术组170例，预后良好者162例（82.41%）。术后新出现脑梗死患者共135例，发生率为20.64%，早期手术组为68例（23.61%），间期手术组为22例（27.16%），晚期手术组为45例（15.79%）。结论单纯从显微外科手术效果分析，无论是近期效果还是远期效果，晚期手术组均优于早期手术组；但晚期手术患者将面临等待晚期手术期间动脉瘤再次出血的风险，因此推荐早期手术；间期手术效果最差，除非合并较大颅内血肿或脑疝者，应尽量避免间期手术。ObjectiveTo study the relationship between operation timing and the prognosis of patients with intracranial aneurysms.Methods In this study, we retrospected and followed up 654 cases of intracranial aneurysm undergoing microsurgical treatment. These patients were divided into groups by the operation timing and the complication of infarction after surgery. All data were analyzed by χ2 test.Results Among 654 cases in this study, 538 （82.26%） got eusemia, of which 231 （80.20%） in early surgery group, 54 （66.67%） in intermediate surgery group and 253 （88.77%） in late surgery group. Among 415 （63.46%） cases of follow-up, 342 （82.41%） got eusemia, of which 153 （79.69%） in early surgery group, 27 （61.36%） in intermediate surgery group and 162 （90.50%） in late surgery group. Among 654 cases of surgery, 135 （20.64%） got new cerebral infarction after surgery, of which 68 （23.61%） in early surgery group, 22 （27.16%） in intermediate surgery group and 45 （15.79%） in late surgery group.Conclusion Operation timing is one of the most important infludencing factors in intracranial aneurysms treatment. The outcome of late surgery is better than early surgery, while the prognosis of intermediate surgery is inferior to early surgery. Patients given late surgery will be confronted with greater risk of aneurysm rupture during the waiting for surgery. Therefore, the early surgery is recommended, while the intermediate surgery is not recommended, unless the patients have massive intracranial hematoma or hernia.

关 键 词：颅内动脉瘤 手术时机 预后 

分 类 号：R651.12[医药卫生—外科学]