荧光造影监测下应用组合夹闭技术治疗前交通动脉瘤102例  

Treatment of 102 cases of anterior communicating artery aneurysm using combined clamp technique under fluorescence imaging monitoring

作　　者：陈江伟 张乐 刘希光 CHEN Jiangwei;ZHANG Le;LIU Xiguang(Department of Neurosurgery,Lianyungang First People's Hospital(Lianyungang Hospital Affiliated to Xuzhou Medical University),Lianyungang,Jiangsu 222000,China)

机构地区：[1]连云港市第一人民医院(徐州医科大学附属连云港医院)神经外科,江苏连云港222000

出　　处：《安徽医药》2023年第6期1149-1154,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的 研究吲哚菁绿(ICG)荧光造影下多瘤夹组合夹闭前交通动脉(ACoA)动脉瘤的手术疗效。方法 回顾分析2018年1月至2020年9月在徐州医科大学附属连云港医院诊治的102例ACoA动脉瘤。根据影像学和动脉瘤的瘤颈与载瘤动脉的解剖学关联分为简单单线型(ⅠA)、复杂单线型(ⅠB)、简单双线型(ⅡA)、复杂双线型(ⅡB)和复杂三线型(Ⅲ),并在荧光造影技术辅助下对复杂ACoA动脉瘤进行组合夹闭,对不同分型和不同夹闭方式的预后结果进行比较分析,出院后3~6个月由医生门诊或电话随同访问,确定病人的预后格拉斯哥预后(GOS)评分。通过多组独立样本方差分析和kruskal-wallis检验比较不同分型下动脉瘤之间的预后差异及不同的夹闭方法对预后的影响。结果 术后3~6个月随访结果显示:102例ACoA动脉瘤病人中,有79例预后良好(GOS评分为4分和5分),16例预后较差(GOS评分为2分和3分),死亡7例,总体预后良好率77.4%。不同分型的动脉瘤,所采用的组合夹闭方法之间存在差异,双线夹闭预后良好比例仍较单线夹闭高。结论 应用双线/多线多瘤夹组合夹闭技术治疗ACoA动脉瘤相较于单线夹闭治疗来说具有潜在优势,可以对改善病人预后起到积极作用,但也有待未来更大样本的研究进一步证实。Objective To analyze the clinical experience and surgical effect of Anterior Communicating Artery(ACoA)aneurysm clipped with multiple clips under indocyanine green(ICG)fluorescein angiography.Methods A retrospective analysis was made on 102 cases of ACoA aneurysm diagnosed and treated in Lianyungang Hospital Affiliated to Xuzhou Medical University from January 2018 to September 2020.According to the imaging and the anatomical correlation between the neck of aneurysm and the carrier artery,the aneurysms were divided into simple unilinear type(ⅠA),complex monolinear type(ⅠB),simple bilinear type(ⅡA),complex bilinear type(ⅡB)and complex trilinear type(Ⅲ).Combined clipping of complex ACoA aneurysms with the aid of fluorescein angiography was performed.The outcomes of different types and different clamping methods were compared and analyzed.The GOS prognosis score of patients discharged from hospital for 3~6 months was determined by outpatient service or telephone follow-up.Chi-square test was used to determine the difference of clinical prognosis of different types of aneurysms and the difference of prognosis among different clipping methods.Results Among the 102 patients with ACoA aneurysm,79 cases had a good prognosis(GOS scores of 4 and 5),16 cases had a poor prognosis(GOS scores of 2 and 3),and 7 cases died,with an overall good prognosis rate 77.4%.There were differences in combined clipping methods for different types of aneurysms,and the proportion of good prognosis of double-line clipping was still higher than that of single-line clipping.Conclusion The application of double-line/multi-line multi-clip combined clipping technique in the treatment of ACoA aneurysms has potential advantages compared with single-line clipping therapy,which can play a positive role in improving the prognosis of patients.

关 键 词：颅内动脉瘤 血管夹 荧光素血管造影术 前交通动脉 组合夹闭 显微手术 

分 类 号：R651.12[医药卫生—外科学]