60岁及以上颅内多发性动脉瘤患者的显微外科手术疗效分析  

Analysis of the efficacy of microsurgery in patients aged 60 years and above with multiple intracra-nial aneurysms

作　　者：陈程 王超[1] 李环廷[1] 张丕宁[1] 栗世方[1] 徐冬梅[1] 郭忠翔 丰育功[1] Chen Cheng;Wang Chao;Li Huanting;Zhang Pining;Li Shifang;Xu Dongmei;Guo Zhongxiang;Feng Yugong(Department of Neurosurgery,Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院神经外科,青岛266003

出　　处：《中华神经外科杂志》2023年第10期1003-1007,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81870914)。

摘　　要：目的探讨显微外科手术治疗60岁及以上颅内多发性动脉瘤(MIA)患者的手术疗效和临床经验.方法回顾性分析1997年12月至2021年12月青岛大学附属医院神经外科采用显微外科手术治疗的111例老年MIA患者的临床资料,其中颅内2个动脉瘤的患者95例,3个14例,4个1例,5个1例;责任动脉瘤111个,非责任动脉瘤130个.根据动脉瘤的位置、大小、形状,101例患者行一期单侧翼点入路,7例行一期冠状入路,3例行翼点入路分期手术治疗夹闭动脉瘤.术后通过影像学随访评估动脉瘤夹闭情况;采用格拉斯哥预后分级(GOS)评估患者的预后.结果111例患者的241个动脉瘤中,完全夹闭216个包括责任动脉瘤111个,非责任动脉瘤105个;其余25个非责任动脉瘤中自体筋膜包裹后生物胶固定2个,包裹后夹闭2个,术前血管内栓塞2个,未做特殊处理19个.22例(19.8%)患者术后发生并发症,其中2例(1.8%)重度残疾,3例(2.7%)植物生存状态,3例(2.7%)死亡.53例患者获得影像学随访,随访时间[M(Q1,Q3)]为8(3,15)个月,末次随访显示,动脉瘤均未见复发.108例患者均获得临床随访,随访时间[M(Q1,Q3)]为23.5(8.0,56.5)个月,至末次随访,预后良好(GOSⅣ~Ⅴ级)103例;预后不良(GOSⅠ~Ⅲ级)5例,其中2例为重度残疾,3例为植物生存状态.结论选择合适的显微外科手术入路治疗老年MIA,有利于降低术后并发症,且致残、致死率低,是一种有效的治疗方法.Objective To explore the therapeutic effect and clinical experience of microsurgery in the treatment of patients with multiple intracranial aneurysms(MIA)aged 60 and over.Methods We retrospectively analyzed the clinical data of 111 elderly patients with MIA who underwent microsurgery in the Department of Neurosurgery,Affiliated Hospital of Qingdao University from December 1997 to December 2021.Among all patients,each of 95 patients had 2 aneurysms,each of 14 had 3 aneurysms,1 patient had 4 aneurysms,and 1 patient had 5 aneurysms.There were a total of 111 offending aneurysms and 130 non-offending aneurysms.According to the location,size and shape of aneurysms,101 patients underwent one-stage surgery via unilateral pterional approach,7 via coronal approach,and 3 underwent staged surgery for aneurysm clipping.Postoperative imaging follow-up was used to evaluate the aneurysm clipping.The Glasgow Outcome Scale(GOS)was used to evaluate the patient′s outcomes.Results Among 241 aneurysms in 111 patients,216 were completely clipped which included 111 offending aneurysms and 105 non-offending aneurysms.Among the 25 non-offending aneurysms,2 were encapsulated with autologous fascia and fixed with bioglue,2 were clipped after encapsulation,2 underwent preoperative intravascular embolization,and 19 cases underwent no particular treatment.A total of 22 patients(19.8%)experienced postoperative complications,including 2(1.8%)cases of severe disability,3(2.7%)cases of persistent vegetative state and 3(2.7%)cases of death.Fifty-three patients received imaging follow-up,and the follow-up time[M(Q1,Q3)]was 8(3,15)months.No recurrence of aneurysm was found.All 108 patients received clinical follow-up,and the follow-up time[M(Q1,Q3)]was 23.5(8.0,56.5)months.There were 103 cases with good outcomes(GOS gradeⅣtoⅤ)and 5 cases with poor outcomes(GOS gradeⅠtoⅢ),all of which 2 cases were severe disability and 3 cases were persistent vegetative state.Conclusion Choosing an appropriate microsurgical approach to treat MIA in the elder

关 键 词：颅内动脉瘤 显微外科手术 治疗结果 老年人 多发动脉瘤 

分 类 号：R651.12[医药卫生—外科学]