经Dolenc入路手术夹闭27例部分复杂性后交通动脉瘤的疗效分析  

Clipping of 27 patients with partial complicated posterior communicating artery aneurysms via Dolenc approach: a clinical efficacy analysis

作　　者：张洪伟 李爱民 刘希光 戴大鹏 明圆圆 张东[2] Zhang Hongwei;Li Aimin;Liu Xiguang;Dai Dapeng;Ming Yuanyuan;Zhang Dong(Department of Neurosurgery,Lianyungang Hospital Affiliated to Xuzhou Medical University,Lianyungang 222002,China;Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]徐州医科大学附属连云港医院神经外科,222002 [2]首都医科大学附属北京天坛医院神经外科,100070

出　　处：《中华神经医学杂志》2020年第10期995-1000,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨经Dolenc入路手术夹闭部分复杂性后交通动脉瘤的疗效及其临床经验。方法回顾性收集徐州医科大学附属连云港医院神经外科及首都医科大学附属北京天坛医院神经外科自2014年7月至2019年6月经Dolenc入路手术夹闭的27例部分复杂性后交通动脉瘤患者的临床资料,分析其临床疗效并总结手术经验。结果术中26例动脉瘤夹闭顺利,1例改行包裹术。术前3例动眼神经麻痹患者中术后2例好转、1例无变化;术后新发4例动眼神经麻痹,经保守治疗后2例恢复正常、1例好转、1例无变化;术后2例发生基底节局灶性脑梗死,1例因脑积水行脑室腹腔分流。26例患者术后2周内DSA或CT血管成像复查均提示动脉瘤完全夹毕、无残留。术后9~12个月内随访示格拉斯哥预后评分5分20例、4分3例、3分2例、2分1例、死亡1例,影像学复查均未见动脉瘤复发。结论经Dolenc入路可通过硬膜外磨除前床突而获得良好的操作空间,充分暴露近端载瘤动脉,从而安全有效地手术夹闭部分复杂性后交通动脉瘤。Objective To explore the clinical experiences and treatment outcomes of partial complicated posterior communicating artery aneurysms(PCoAs)via Dolenc approach.Methods The clinical data of 27 patients with partial complicated PCoAs accepted clipping via Dolenc approach in our hospitals from July 2014 to June 2019 were retrospectively reviewed.The clinical efficacies were analyzed and the surgical experiences were summarized in these patients.Results Among 27 patients with partial complicated PCoAs,26 accepted clipping successfully via Dolenc approach,and one accepted clipping and wrapping.For clinical ourcomes,2 out of 3 patients with preoperative oculomotor paralysis got improvement after surgery,and one was without change;in 4 patients with new-onset oculomotor paralysis after surgery,2 returned to normal after conservative treatment,one got improvement,and one was without change.After surgery,2 had basal ganglia focal cerebral infarction and one had ventriculoperitoneal shunt due to hydrocephalus.DSA or CTA examination within two weeks after surgery showed all 26 aneurysms were completely clipped and without residual.During the 9-12 months of follow up,Glasgow outcome scale(GOS)showed that 20 patients had GOS 5 scores,3 had GOS 4 scores,2 had GOS 3 scores,one had GOS 2 scores,and one died.No patients showed aneurysm recurrent in the imaging examination.Conclusion Via Dolenc approach,anterior clinoid process and its surrounding bony structures are drilled off via extradural way,and proximal of parent artery is exposed well,therefore,more operation space can be provided to deal with partial complicated PCoAs.

关 键 词：Dolenc入路 部分复杂性后交通动脉瘤 前床突 

分 类 号：R651.12[医药卫生—外科学]