两种颅内动脉瘤包裹夹闭方式的疗效分析  

Analysis of the therapeutic effects of two methods of wrapping and clamping intracranial aneurysms

作　　者：郭张超 张德明[1] 杜春富 吴建兵 张杰[1] GUO Zhangchao;ZHANG Deming;DU Chunfu;WU Jianbing;ZHANG Jie(Ya’an People’s Hospital,Ya’an 625000,China)

机构地区：[1]雅安市人民医院,四川雅安625000

出　　处：《中国实用神经疾病杂志》2023年第12期1527-1531,共5页Chinese Journal of Practical Nervous Diseases

基　　金：四川第四批省级科技计划项目(编号:2019ZYZF0063);雅安市重点科技计划项目(编号:21KJJH0011)。

摘　　要：目的探讨前循环动脉瘤包裹夹闭方式与术中先行制作合适膜片固定于动脉瘤夹上再行包裹夹闭方式的临床疗效。方法选取2018-01—2022-07雅安市人民医院收治的行颅内动脉瘤包裹夹闭术的前循环动脉瘤患者46例,根据术中包裹夹闭方式分为2组进行回顾性分析。A组24例为传统的动脉瘤包裹方式,使用膜片包裹动脉瘤后行动脉瘤包裹夹闭;B组22例为术中根据动脉瘤情况先制作合适膜片固定于适宜动脉瘤夹上后再行动脉瘤包裹夹闭。比较2组患者一般情况、术中动脉瘤破裂情况、术中出血量、术中阻断时间、术后梗死和再次出血情况以及术后6个月格拉斯哥预后量表(GOS)评分。结果2组在年龄、性别、动脉瘤部位和大小、术前Hunt-Hess及Fisher分级等构成上均无统计学差异(均P>0.05)。B组术中动脉瘤再次破裂率(22.7%)、术后梗死和再出血率(9.1%)均低于A组(33.3%,20.1%),但差异无统计学意义(分别为χ^(2)=1.183、0.486,均P>0.05)。B组术中阻断时间、术中出血量及术后6个月GOS评分均明显优于A组,差异有统计学意义(分别为χ^(2)=4.330,t=1.516,χ^(2)=6.303,均P<0.05)。结论在前循环动脉瘤中两种方式比较,术中先制作合适膜片固定于动脉瘤夹上再行包裹夹闭方式,可减少术中出血量,缩短阻断时间,临床疗效较好。Objective To explore the clinical efficacy of anterior circulating aneurysmal wrapping and clamping method and the subsequent wrapping and clamping method by making a suitable diaphragm and fixing it on the aneurysmal clamp.Methods Forty-six patients with anterior circulating aneurysms who underwent intracranial aneurysm encapsulation and clipping in Ya’an People’s Hospital from January 2018 to July 2022 were selected and divided into two groups according to intraoperative encapsulation methods for retrospective analysis.In group A,24 patients were treated by traditional aneurysmal encapsulation,which was followed by aneurysmal encapsulation and clipping.In group B,22 patients underwent aneurysm wrapping and clamping after making appropriate diaphragm and fixing it on appropriate aneurysm clamp according to the condition of aneurysm.The general situation,intraoperative aneurysm rupture,intraoperative blood loss,intraoperative occlusion time,postoperative infarction and rebleeding,and Glasgow outcome scale(GOS)score 6 months after surgery were compared between the two groups.Results There were no significant differences in age,sex,aneurysm site and size,preoperative Hunt-Hess scores and Fisher grades between the two groups(all P>0.05).The rates of intraoperative aneurysm rerupture(22.7%),postoperative infarction and rebleeding(9.1%)in group B were lower than those in group A(33.3%,20.1%),but the differences were not significant enough(χ^(2)=1.183,0.486,respectively,all P>0.05).However,in terms of intraoperative occlusion time,intraoperative blood loss and GOS score 6 months after surgery,group B was significantly better than group A,and the differences were statistically significant(χ^(2)=4.330,t=1.516,χ^(2)=6.303,respectively,all P<0.05).Conclusion The appropriate diaphragm is made to fix on the aneurysm clip and then wrapped and closed during surgery,which can reduce the amount of intraoperative bleeding,shorten the blocking time,and have better clinical efficacy.

关 键 词：颅内动脉瘤 前循环 包裹夹闭 动脉瘤破裂 

分 类 号：R743[医药卫生—神经病学与精神病学]