经额外侧锁孔与经翼点入路夹闭前交通动脉瘤术后认知功能障碍及神经损伤的影响比较  

A retrospective cohort study on cognitive dysfunction and brain nerve injury after clipping of anterior communicating aneurysm via frontolateral keyhole versus transpterional approach

作　　者：张海 曾令勇 徐剑峰 刘阳 江涌 钟婷婷 黎新慎 张波 ZHANG Hai;ZENG Ling-yong;XU Jian-feng;LIU Yang;JIANG Yong;ZHONG Ting-ting;LI Xin-shen;ZHANG Bo(Department of Neurosurgery,Sichuan Mental Health Center/Mianyang Third People's Hospital,Mianyang 621000,Sichuan,China;不详)

机构地区：[1]四川省精神卫生中心、绵阳市第三人民医院神经外科,四川绵阳621000 [2]西南医科大学附属医院神经外科,四川泸州646000

出　　处：《广东医学》2022年第1期108-112,共5页Guangdong Medical Journal

基　　金：绵阳市第三人民医院科研立项课题重点培育项目(202006,202007)。

摘　　要：目的比较额外侧锁孔开颅与翼点开颅前交通动脉瘤(anterior communicating artery aneurysm,AcoA)夹闭术后认知功能障碍的变化,并对比以上两种AcoA开颅夹闭术后的神经损伤及恢复情况。方法按照标准纳入住院治疗的51例破裂AcoA(瘤体指向均为下或前下),随机分为经翼点入路组24例(A组)和经额外侧锁孔入路组27例(B组),另有健康自愿者24例作对照组(C组)。3组分别于入组后14 d及1、3、6个月进行简易精神状态量表(mini-mental state examination,MMSE)测定和血清S100B蛋白检测。结果A组和B组间入组后14 d及1、3、6个月的MMSE评分,比较差异无统计学意义(P>0.05),而C组与A组和B组分别比较差异均有统计学意义(P<0.01);对比A组、B组和C组在入组后14 d及1、3、6个月MMSE评分的变化趋势,B组相对于A组能够更早接近C组的正常水平。各个观测时间点上3组患者血清S100B测值结果显示:在14 d和1个月时,A组、B组分别与C组比较,S100B值差异均有统计学意义(P<0.01);在3个月时,A组与C组比较S100B值差异有统计学意义(P<0.05),但B组与C组比较,S100B值差异无统计学意义(P>0.05);在6个月时,A组、B组分别与C组比较,S100B值差异均无统计学意义(P>0.05)。A组和B组在4个时间点S100B值比较的差异均无统计学意义(P>0.05)。结论破裂AcoA患者相比健康人,发病后存在明显的脑神经损伤和不同程度的认知功能障碍。脑神经损伤在发病后逐渐趋于正常水平,但认知功能障碍可持续存在。经额外侧锁孔入路相比经翼点入路夹闭AcoA,术后认知功能障碍恢复速度较快。经额外侧锁孔入路具有安全有效、微创美观、便捷经济等特点,相对于传统翼点入路手术夹闭AcoA具有一定优势。Objective To compare the cognitive dysfunction,nerve injury and recovery after clipping anterior communicating aneurysm(AcoA)via frontolateral keyhole with transpterional approach.Methods The study included 51 cases of ruptured AcoA(anterior-inferior or posterior direction on the sagittal plane),and they were randomly divided into a transpterional approach group(Group A,n=24)and frontolateral keyhole approach group(Group B,n=27).We also recruited 24 healthy volunteers as a control group(Group C).Mini-mental State Examination(MMSE)score and serum S100B test were performed on these cases 2 weeks,1 month,3 months and 6 months after enrollment.Results There was no significant difference in MMSE scores 2 weeks,1 month,3 months or 6 months after enrollment between Group A and Group B(P>0.05);but there were significant differences between Group C and Group A or B(P<0.01).The MMSE scores recovered to normal earlier in Group B than those in Group A.There were significant differences in serum S100B 2 weeks and 1 month after enrollment when Group A and Group B compared with Group C(P<0.01).Three months after enrollment,there was significant difference in S100B between Group A and C(P<0.05),while there was no significant difference between Group B and C(P>0.05).There was no significant difference between Group A and Group B during the follow-up after enrollment(P>0.05).Conclusion Compared with healthy people,patients with ruptured AcoA have obvious central nerve injury and cognitive dysfunction after the onset.Brain nerve injury could gradually tend to normal level after the onset of AcoA rupture,but the cognitive dysfunction seems to exist for a long time.Compared with transpterional approach,frontolateral keyhole approach provides a faster recovery of cognitive dysfunction after surgery.The extra lateral keyhole approach is safe,effective,minimally invasive,convenient and economical,and has more advantages than the traditional pterional approach.

关 键 词：前交通动脉瘤夹闭术 额外侧锁孔入路 翼点入路 认知功能障碍 脑神经损伤 

分 类 号：R615[医药卫生—外科学] R459.7[医药卫生—临床医学]