眶上外侧入路在颅内前循环动脉瘤破裂急性期显微夹闭手术中的应用价值  

Application value of microsurgical clipping via lateral supraorbital approach on intracranial anterior circulation aneurysm rupture in acute stage

作　　者：黄小龙 张晓强 黄浩 胡齐 孙凌云 HUANG Xiaolong;ZHANG Xiaoqiang;HUANG Hao;HU Qi;SUN Lingyun(Department of Neurosurgery,West China Guang′an Hospital(Guang′an People′s Hospital),Sichuan University,Guang′an,Sichuan 638001)

机构地区：[1]四川大学华西广安医院(广安市人民医院)神经外科,四川广安638001

出　　处：《郑州大学学报（医学版）》2023年第3期424-428,共5页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:观察眶上外侧入路(LSO入路)在颅内前循环动脉瘤破裂急性期显微夹闭手术中的应用价值,并与常规翼点入路(PT入路)对比。方法:收集2019年3月至2022年3月收治的98例行显微夹闭手术的颅内前循环动脉瘤破裂急性期患者的临床资料,根据手术入路分为LSO组(44例)和PT组(54例)。比较2组围术期指标及并发症发生率;于术前、术后第1天检测血清炎症因子[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、内皮素-1(ET-1)]变化;术后随访3个月,采用格拉斯哥预后评分(GOS评分)评价预后。结果:LSO组手术时间、切口长度、术中出血量及术后住院时间均短于或小于PT组[(155.84±24.16)min vs(179.45±21.72)min,(9.44±1.28)cm vs(15.05±2.62)cm,(63.62±15.84)mL vs(185.82±39.48)mL,(15.68±4.12)d vs(19.25±4.46)d,P均<0.001]。LSO组并发症总发生率低于PT组(13.6%vs 35.2%,P=0.015)。术后第1天,2组血清TNF-α、IL-6、ET-1水平均较术前升高,但LSO组升高幅度均低于PT组(P<0.05)。术后3个月,2组预后良好率差异无统计学意义(95.4%vs 90.7%,P=0.454)。结论:相比常规PT入路,颅内前循环动脉瘤破裂急性期显微夹闭手术采用LSO入路在减少手术创伤、缩短手术时间和住院时间、降低并发症发生率方面更具优势。Aim:To observe the application value of microsurgical clipping via lateral supraorbital approach(LSO approach)in the treatment of acute stage intracranial anterior circulation aneurysm rupture,and to compare with conventional pterional approach(PT approach).Methods:Clinical data of 98 patients with intracranial anterior circulation aneurysm rupture in acute stage who underwent microsurgery from March 2019 to March 2022 were retrospectively analyzed.The patients were allocated into LSO group(LSO approach surgery,44 cases)and PT group(PT approach surgery,54 cases).The perioperative indicators and incidence rates of complications were compared between the 2 groups.The serum inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),endothelin-1(ET-1)]were determined before surgery and on the 1st day after surgery.At the end of 3 month follow-up,the prognosis was evaluated by Glasgow Outcome Scale(GOS)score.Results:The surgical time,incision length,intraoperative blood loss and postoperative hospital stay in LSO group were all shorter or less than those in PT group[(155.84±24.16)min vs(179.45±21.72)min,(9.44±1.28)cm vs(15.05±2.62)cm,(63.62±15.84)mL vs(185.82±39.48)mL,(15.68±4.12)days vs(19.25±4.46)days,all P<0.001].The total incidence rate of complications was lower in LSO group than that in PT group(13.6%vs 35.2%,P=0.015).The increases of serum TNF-α,IL-6 and ET-1 in LSO group were lower compared with those in PT group(P<0.001).At the end of 3 month follow-up,there was no statistical significance in the good prognosis rate of GOS between the 2 groups(95.4%vs 90.7%,P=0.454).Conclusion:Compared with conventional PT approach,LSO approach for patients with acute stage intracranial anterior circulation aneurysm rupture undergoing microsurgical clipping is more advantageous in reducing surgical trauma,shortening operation time and hospital stay,and lowering complications.

关 键 词：颅内前循环动脉瘤破裂 急性期 显微夹闭手术 眶上外侧入路 翼点入路 

分 类 号：R651.1[医药卫生—外科学]