影响经翼点入路夹闭破裂前交通动脉动脉瘤预后的临床因素分析  

Prognostic clinical factor analysis of clipping surgery for unruptured anterior communicating artery aneurysm via pterional approach

作　　者：万大海[1] 杨钰桢 马宁[1] Wan Dahai;Yang Yuzhen;Ma Ning(Department of Neurosurgery,the First Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院神经外科,太原030001

出　　处：《中华神经外科杂志》2019年第7期708-711,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨影响经翼点入路夹闭破裂前交通动脉动脉瘤预后的相关临床因素。方法回顾性纳入2014年1月至2018年7月山西医科大学第一医院神经外科收治的113例破裂前交通动脉动脉瘤患者,均采用经翼点入路夹闭术治疗。术后6个月对所有患者行门诊和(或)电话随访,根据格拉斯哥预后评级(GOS)评估患者预后,其中Ⅳ~Ⅴ级为预后良好,Ⅰ~Ⅲ级为预后不良。采用单因素和多因素logistic回归分析影响前交通动脉动脉瘤患者预后的相关临床因素。结果113例患者手术均成功。术后33例发生脑缺血事件,23例脑挫裂伤,4例脑积水,9例颅内感染,1例肺部感染;经对症治疗后患者症状缓解。1例因大面积脑梗死死亡。112例患者均获得随访,其中97例(86.6%)为预后良好,15例(13.4%)为预后不良。单因素分析结果显示,患者的性别、动脉瘤分型、动脉瘤大小、手术时机、手术侧别及术后并发症对预后均无明显影响(均P>0.05),而患者的年龄、原发性高血压及Hunt-Hess分级是预后的影响因素(均P<0.05);进一步多因素logistic回归分析显示,Hunt-Hess分级是影响预后的独立危险因素(OR=3.470,95%CI:1.775~6.782,P<0.001)。结论Hunt-Hess分级是影响经翼点入路夹闭破裂前交通动脉瘤预后的独立危险因素。Objective To analyze the factors that influence the prognosis in patients with unruptured anterior communicating artery (ACoA) aneurysm through pterional approach. Methods We performed a retrospective study of 113 cases with ACoA aneurysms admitted to Department of Neurosurgery, the First Affiliated Hospital of Shanxi Medical University from January 2014 to July 2018. All cases underwent clipping of aneurysms through pterional approach. Clinical follow-up was performed at 6 months post surgery through telephone at outpatient clinics. The Glasgow Outcome Scale (GOS) was used for outcome assessment: grade Ⅳ-Ⅴ for good outcome and grade Ⅰ-Ⅲ for poor outcome. Univariate and multivariate logistic regression were used to analyze the prognostic factors in patients with ACoA aneurysm. Results All 113 patients underwent successful operation. During postoperative period, there were 33 cases of cerebral ischemic events, 23 cases of brain contusion, 4 cases of hydrocephalus, 9 cases of intracranial infection and 1 case of lung infection. After symptomatic treatment, the patient's symptoms were relieved. One case died of massive cerebral infarction. There were 112 patients who were followed up. Good outcomes were achieved in 97 (86.6%) patients and poor outcomes in 15 (13.4%) patients. Univariate analysis revealed that age, history of hypertension and Hunt-Hess grade were closely related to the prognosis (all P<0.05). Gender, morphological characteristics of aneurysm, size, timing, approach of surgery and postoperative complications were not related to the prognosis (all P>0.05). Multivariate logistic regression analysis revealed that Hunt-Hess grade (OR=3.470, 95% CI: 1.775-6.782, P<0.001) was the independent risk factor affecting the outcomes of patients. Conclusion Hunt-Hess grade seems to be the independent risk factor affecting the outcomes of clipping surgery for unruptured ACoA aneurysm via pterional approach.

关 键 词：颅内动脉瘤 预后 因素分析 统计学 前交通动脉 经翼点入路 

分 类 号：R651.12[医药卫生—外科学]