眶上外侧入路手术夹闭胚胎型大脑后动脉起源的破裂后交通动脉动脉瘤  

Surgical clipping of ruptured posterior communicating artery aneurysms originating from fetal-type posterior cerebral artery via lateral supraorbital approach

作　　者：盛文乾君 贾若飞 夏俊[2] 钟金浩 Sheng Wenqianjun;Jia Ruofei;Zhang Kehui(Department of Neurosurgery,Foshan Hospital of Traditional Chinese Medicine,Foshan 528000,China)

机构地区：[1]佛山市中医院神经外科,528000 [2]常德市第一人民医院神经外科,415000

出　　处：《国际脑血管病杂志》2022年第8期584-588,共5页International Journal of Cerebrovascular Diseases

基　　金：佛山市卫生健康局学科研课题(20200301)。

摘　　要：目的探讨经眶上外侧入路夹闭术对胚胎型大脑后动脉(fetal-type posterior cerebral artery, FPCA)起源的破裂后交通动脉动脉瘤(posterior communicating artery aneurysm, PCoAA)的治疗效果以及转归影响因素。方法回顾性纳入2015年1月至2020年5月在佛山市中医院和常德市第一人民医院脑血管中心接受经眶上外侧入路夹闭术的伴有FPCA的破裂PCoAA患者。在术后6个月采用格拉斯哥转归量表评估患者转归, 4~5分定义为转归良好, 1~3分定义为转归不良。采用多变量logistic回归分析确定转归不良的危险因素。结果共纳入119例患者, 女性98例(82.35%), 年龄(61.59±11.52)岁(范围32~78岁), 30例(25.21%)患者转归不良。多变量logistic回归分析显示, 年龄[优势比(odds ratio,OR) 2.935, 95%置信区间(confidence interval,CI)2.117~5.391;P=0.012]、高血压(OR 2.016, 95%CI 1.568~4.335;P=0.023)、Hunt-Hess分级(OR 2.408, 95%CI 1.326~5.068;P<0.001)、改良Fisher分级(OR 3.034, 95%CI 2.201~5.517;P<0.001)、动脉瘤大小(OR 1.793, 95%CI 1.427~2.622;P=0.009)、术前颅内血肿体积(OR 1.246, 95%CI 1.055~2.153;P=0.011)和手术时机(OR 2.152, 95%CI 1.316~3.240;P=0.006)是患者转归不良的独立危险因素。结论经眶上外侧入路夹闭术能有效治疗伴有FPCA的破裂PcoAA。年龄>65岁、有高血压史、高Hunt-Hess分级、高改良Fisher分级、动脉瘤>7.65 mm、术前颅内血肿量>19.02 ml且较晚手术的患者需要加强术后管理以改善转归。Objective To investigate the therapeutic effect of surgical clipping ruptured posterior communicating artery aneurysms(PCoAA)originating from fetal-type posterior cerebral artery(FPCA)via lateral supraorbital approach and the influencing factors of the outcomes.Methods Patients with ruptured PCoAA originating from FPCA underwent surgical clipping via lateral supraorbital approach in the Cerebrovascular Center of Foshan Hospital of Traditional Chinese Medicine from January 2017 to May 2020 were retrospectively enrolled.The Glasgow Outcome Scale was used to evaluate the outcomes of patients at 6 months after operation.4-5 points were defined as good outcome,and 1-3 points were defined as poor outcome.Multivariable logistic regression analysis was used to determine the risk factors for poor outcomes.Results A total of 119 patients were enrolled,including 98 females(82.35%),aged 61.59±11.52 years old(range 32-78 years).Thirty patients(25.21%)had poor outcomes.Multivariable logistic regression analysis showed that age(odds ratio[OR]2.935,95%confidence interval[CI]2.117-5.391;P=0.012),hypertension(OR 2.016,95%CI 1.568-4.335;P=0.023),Hunt-Hess grade(OR 2.408,95%CI 1.326-5.068;P<0.001),modified Fisher grade(OR 3.034,95%CI 2.201-5.517;P<0.001),aneurysm size(OR 1.793,95%CI 1.427-2.622;P=0.009),preoperative intracranial hematoma volume(OR 1.246,95%CI 1.055-2.153;P=0.011)and surgical timing(OR 2.152,95%CI 1.316-3.240;P=0.006)were the independent risk factors for poor outcomes of the patients.Conclusions Surgical clipping via lateral supraorbital approach can effectively treat the ruptured PcoAA with FPCA.Patients with age>65 years,with a history of hypertension,high Hunt-Hess grade,high modified Fisher grade,aneurysms>7.65 mm,preoperative intracranial hematoma volume>19.02 ml,and late surgery need to strengthen postoperative management to improve outcomes.

关 键 词：颅内动脉瘤 动脉瘤 破裂 蛛网膜下腔出血 大脑后动脉 治疗结果 

分 类 号：R651.12[医药卫生—外科学]