复合手术治疗颅内动脉瘤破裂致蛛网膜下腔出血疗效观察  

Assessment of the efficacy of composite surgery for the treatment of ruptured intracranial aneurysm-induced subarachnoid hemorrhage

作　　者：朱顺利 张玉龙 刘振法 王晖 石明亮 李江琳[2] ZHU Shun-Li;ZHANG Yu-Long;LIU Zhen-Fa;WANG Hui;SHI Ming-Liang;LI Jiang-Lin(Department of General Surgery,Kaifeng Hospital of Traditional Chinese Medicine,Kaifeng 475002,China;Department of Teaching and Research Surgery,The First Affiliated Hospital Of Henan University,Kaifeng 475001,China)

机构地区：[1]开封市中医院神经外科,开封475002 [2]河南大学第一附属医院外科教研室,开封475001

出　　处：《国际神经病学神经外科学杂志》2019年第6期641-644,共4页Journal of International Neurology and Neurosurgery

基　　金：国家自然科学基金项目(81601368);河南省科技攻关计划项目(172102310284);开封市科技发展计划项目(1603085);河南省高等学校重点科研项目计划(168320005);河南大学本科教学改革研究与实践项目(HDXJJG2018-131);河南大学临床医学院教研项目(LCYX1902)

摘　　要：目的对比研究复合手术与栓塞手术治疗颅内动脉瘤破裂致蛛网膜下腔出血疗效。方法回顾性描述性研究2016年1月至2018年12月开封市中医院和河南大学第一附属医院治疗颅内动脉瘤破裂致蛛网膜下腔出血的13例复合手术与16例栓塞手术病例。结果术后栓塞组术后发生2例脑积水、1例脑梗死、1例脑血管痉挛,复合组未发生;两组各有1例发生术后肺部感染;复合组2例发生术后颅内感染,栓塞组未发生;两组各有1例发生术后下肢深静脉血栓形成。两组均无围手术期死亡病例。两组并发症发生有统计学差异(P<0.05)。出院时复合组有4例功能障碍,栓塞组有8例功能障碍;两组出院及随访GOS分级有统计学差异(P<0.05)。栓塞组1例1年内动脉瘤再破裂出血,复合组未发生,两组有统计学差异(P<0.05)。结论复合手术在颅内动脉瘤致蛛网膜下腔出血治疗上有一定优势。Objective To compare the efficacy of composite surgery and embolization in the treatment of ruptured intracranial aneurysm(RICA)-induced subarachnoid hemorrhage(SAH).Methods A retrospective and descriptive analysis was conducted in patients with RICA-induced SAH(13 cases undergoing composite surgery[CS group]and 16 cases undergoing embolization[E group])treated in Kaifeng Hospital of Traditional Chinese Medicine and the First Affiliated Hospital of Henan University from January 2016 to December 2018.Results Postoperative complications that occurred in the E group but not in the CS group were hydrocephalus(2 cases),cerebral infarction(1 case),cerebral vasospasm(1 case),and fungal infection-induced diarrhea(1 case).Postoperative complications that occurred in the CS group but not in the E group were intracranial infection(2 cases)and urinary tract infection(1 case).Postoperative complications that occurred in both groups were pulmonary infection(1 case for each group)and deep vein thrombosis of the lower extremities(1 case for each group).There were no perioperative deaths in either group.There were significant differences in the incidence of complications between the two groups(P<0.05).At the time of discharge,there were 4 and 8 cases of dysfunction in the CS group and the E group,respectively.There were significant differences in the Glasgow Outcome Scale on discharge and at follow-up between the two groups(P<0.05).Recurrent hemorrhage caused by ruptured aneurysms within 1 year occurred in the E group(1 case)but not in the CS group,yielding a significant difference between the two groups(P<0.05).Conclusions Composite surgery has some advantages in the treatment of RICA-induced SAH.

关 键 词：复合手术 颅内动脉瘤 蛛网膜下腔出血 

分 类 号：R651.12[医药卫生—外科学]