不规则瘤颈的颅内破裂动脉瘤与夹闭术后脑梗死的相关性研究  

Study relationship between irregular aneurysm neck and cerebral infarction after clipping of ruptured intracranial aneurysm

作　　者：徐伦[1] 张旭伟[1] 顾艳[2] 刘永保[2] 刘希光[2] 张洪伟[2] XU Lun;GU Yan;ZHANG Xu-wei(Department of Neurosurgy,Lianyungang Hospital of Traditional Chinese Medicine,Jiangsu 222004,China)

机构地区：[1]连云港市中医院,江苏222004 [2]连云港市第一人民医院

出　　处：《放射学实践》2021年第10期1200-1204,共5页Radiologic Practice

基　　金：江苏省卫生健康委面上项目基金(H2018091)。

摘　　要：目的:分析动脉瘤颈部形态对颅内破裂动脉瘤夹闭术后脑梗死的影响。方法:回顾性分析连云港市第一人民医院203例经显微夹闭术的颅内破裂动脉瘤患者。术前通过CTA确定动脉瘤体形态和颈部形态。据动脉瘤颈部形态是否规则将动脉瘤分为两组,然后据术后是否出现脑梗死将动脉瘤分为两组,分别将两组间的动脉瘤形态和临床指标进行分析,其中术后相关脑梗死的预后因素使用单变量和多变量统计分析确定。结果:203例破裂动脉瘤中动脉瘤形态不规则81例,规则122例。动脉瘤颈部形态不规则65例,形态规则138例。发生术后相关脑梗死40例,总的脑梗死发生率19.7%。动脉瘤颈部形态不规则的动脉瘤伴有较高的瘤体形态不规则出现率(χ^(2)=37.494,P<0.001)、术中破裂率(χ^(2)=11.604,P=0.001)、临时载瘤动脉使用率(χ^(2)=59.286,P<0.001)和术后脑梗死发生率(χ^(2)=21.262,P<0.001)。多变量分析中不规则颈部形态(OR=3.023,95%CI=1.291~7.075,P=0.011)和术中载瘤动脉瘤临时阻断(OR=2.762,95%CI=1.152~6.622,P=0.023)是术后发生脑梗死的相关预后因素。结论:显微手术夹闭颅内破裂动脉瘤中动脉瘤颈部形态不规则和术中载瘤动脉瘤临时阻断是发生术后相关脑梗死的相关预后因素。Objective:To analyze the impact of aneurysm neck shape on cerebral infarction after ruptured intracranial aneurysm microclipping.Methods:Two hundred and three patients with ruptured intracranial aneurysm microclipping were enrolled in this study.The shape of aneurysm body and neck determined by preoperative CTA were retrospectively analyzed.Aneurysms were divided into regular or irregular groups according to the shape of neck,and then those were divided into two groups according to whether there was cerebral infarction after operation.The aneurysm morphology and clinical indicators were analyzed and compared between the groups.The prognostic factors for postoperation-associated cerebral infarction were determined using univariate and multivariate statistical analysis.Results:Among all cases,ruptured aneurysms is irregular in 81 cases and regular in 122 cases.Neck of aneurysm was irregular in 65 cases and regular in 138 cases.Forty people suffered with postoperative related cerebral infarction and the total cerebral infarction rate is 19.7%.Irregular neck of aneurysm was associated with higher incidence of irregular aneurysm body(χ^(2)=37.494,P<0.001),intraoperative rupture(χ^(2)=11.604,P=0.001),using temporary clipping(χ^(2)=59.286,P<0.001),and postoperative cerebral infarction(χ^(2)=21.262,P<0.001).Irregular aneurysm neck(OR=3.023,95%CI=1.291~7.075,P=0.011)and temporary clipping(OR=2.762,95%CI=1.152~6.622,P=0.023)are prognostic factors for postoperative cerebral infarction by the multivariate analysis.Conclusion:Irregular aneurysm neck and temporary clipping are prognostic factors for postoperative related cerebral infarction in patients with ruptured intracranial aneurysm microclipping.

关 键 词：动脉瘤 破裂 脑梗死 体层摄影术 X线计算机 血管造影术 

分 类 号：R543.16[医药卫生—心血管疾病] R743.33[医药卫生—内科学]