大脑中动脉瘤显微手术夹闭治疗的效果分析  

Effect analysis of microsurgical clipping treatment of middle cerebral aneurysms

作　　者：张力[1] 王汉东[1] 潘云曦[1] 丁可[1] 祝剑虹[1] 茅磊[1] Zhang Li;Wang Handong;Pan Yunxi;Ding Ke;Zhu Jianhong;Mao Lei(Department of Neurosurgery,General Hospital of Eastern War Zone,Nanjing 210002,China)

机构地区：[1]东部战区总医院(原南京军区南京总医院)神经外科,南京210002

出　　处：《中国脑血管病杂志》2019年第2期66-71,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金青年科学基金项目(81702484)

摘　　要：目的探讨显微手术夹闭治疗大脑中动脉瘤(MCAA)的安全性和有效性。方法回顾性分析东部战区总医院神经外科2008年5月至2018年5月连续收治的241例(258个动脉瘤)行显微手术夹闭治疗的MCAA患者的临床及影像资料,包括160例(172个动脉瘤)破裂动脉瘤患者(破裂组)和81例(86个动脉瘤)未破裂动脉瘤患者(未破裂组)。手术采用经翼点入路动脉瘤夹闭术或动脉瘤夹闭术+血肿清除术。采用格拉斯哥昏迷量表(GCS)评分评估破裂组患者术前及术后的意识状态。术后定期进行临床及影像学[CT血管成像(CTA)或DSA)]随访。采用SPSS 20. 0统计软件分析处理数据。结果两组患者术中动脉瘤均被完全夹闭。破裂组160例患者,术前GCS评分(8±2)分,9例术后出现大脑中动脉分支供血区域的脑梗死,3例术后出现脑积水,2例术后出现不明原因的脑出血,术后并发症发生率为8. 8%(14/160);术后复查CT血管成像或DSA均未见动脉瘤,术后(15±2) d GCS评分[(9±3)分]较术前改善(t=-6. 240,P <0. 01),78例患者随访无动脉瘤复发。81例未破裂组患者中,7例(8. 6%)术后出现大脑中动脉分支供血区域的脑梗死,术后复查CTA或DSA均未见动脉瘤,45例患者随访无动脉瘤复发。两组术后并发症发生率比较,差异无统计学意义(χ~2=3. 280,P=0. 194)。结论显微手术夹闭是治疗MCAA安全、有效的方法,对动脉瘤破裂患者意识状态的改善非常重要。Objective To investigate the safety and effectiveness of microsurgical clipping for the treatment of middle cerebral artery aneurysms(MCAA).Methods From May 2008 to May 2018,the clinical and imaging data of 241 consecutive patients with MCAA(258 aneurysms)treated with microsurgical clipping at the Department of Neurosurgery,General Hospital of Eastern War Zone were analyzed retrospectively,including 160 patients(172 aneurysms)with ruptured aneurysm(ruptured group)and 81 patients(86 aneurysms)with unruptured aneurysm(unruptured group).Aneurysm clipping or aneurysm clipping+hematoma evacuation was used via pterion approach.The Glasgow coma scale(GCS)score was used to evaluate the state of consciousness before and after surgery in patients of the ruptured group.The clinical and imaging follow-ups(CT angiography[CTA]or DSA)were performed regularly after procedure.SPSS 20.0 statistical software was used to analyze and process the data.Results All the aneurysms were completely clipped during the operation in both groups.Of the 160 patients in the ruptured group,the preoperative GCS score was 8±2,9 had cerebral infarction in the blood supply area of middle cerebral artery branches after operation,3 had hydrocephalus after operation,and 2 had unexplained cerebral hemorrhage after operation.The incidence of postoperative complications was 8.8%(14/160).No aneurysm was found on CT angiography or DSA after procedure.Postoperative GCS score 9±3 at 15±2 d was improved compared with the preoperative GCS score(t=-6.240,P<0.01).Seventy-eight patients were followed up without aneurysm recurrence.Of the 81 patients in the unruptured group,7(8.6%)had cerebral infarction in the blood supply area of middle cerebral artery branches after operation.No aneurysms recurrence was found on CTA or DSA after operation,and 45 patients were followed up without aneurysm recurrence.There was no significant difference in the incidence of postoperative complications between the two groups(χ^2=3.280,P=0.194).Conclusion Microsurgery clipping is a

关 键 词：动脉瘤 大脑中动脉 显微手术夹闭 意识状态 

分 类 号：R651.12[医药卫生—外科学]