非优势供血侧眶上锁孔入路显微手术治疗破裂前交通动脉瘤的临床疗效  

Clinical effect of microsurgical clipping via supraorbital keyhole approach of non-dominant feeder for ruptured anterior communicating artery aneurysm

作　　者：杨德红 万宇晖 杨凯 陈爱林[1] 戴纯刚[1] 陈延明[1] 陈炳霖 朱卿[1] Yang Dehong;Wan Yuhui;Yang Kai;Chen Ailin;Dai Chungang;Chen Yanming;Chen Binglin;Zhu Qing(Department of Neurosurgery,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)

机构地区：[1]苏州大学附属第二医院神经外科,江苏苏州215004

出　　处：《中华脑血管病杂志（电子版）》2024年第2期115-120,共6页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：苏州市科技发展计划项目(SKY2023054,SKJYD2021088,SYS2019067);苏州大学附属第二医院科研预研基金项目(SDFEYBS2217)。

摘　　要：目的探讨非优势供血侧眶上锁孔入路显微手术治疗破裂前交通动脉瘤的临床疗效。方法回顾性分析苏州大学附属第二医院2016年1月至2020年10月69例接受眶上锁孔入路显微手术治疗的破裂前交通动脉瘤患者的临床资料,其中经非优势供血侧入路32例,经优势供血侧入路37例。采用单因素分析比较2组病例的手术时间、术中动脉瘤破裂率、术中动脉瘤夹使用个数、是否切除额叶直回、动脉瘤夹闭不全率、前交通动脉瘤复合体变异扭转率及预后情况的差异。结果非优势供血侧入路组与优势供血侧入路组的手术时间分别为(190±61)min和(204±55)min,术中发生动脉瘤破裂分别有9例(24.3%)和4例(12.5%),术中动脉瘤夹使用个数分别为(1.38±0.61)个和(1.35±0.63)个,额叶直回切除率分别为37.5%(12/32)和48.6%(18/37),动脉瘤夹闭不全率分别为3.1%(1/32)和2.7%(1/37),前交通动脉瘤复合体变异扭转率分别为50.0%(16/32)和37.8%(14/37),出院时预后良好率分别为78.1%(25/32)和75.7%(28/37),出院后1个月、3个月、6个月、12个月的预后良好率均分别为78.1%(25/32)和73.0%(27/37),差异均无统计学意义(P均>0.05)。结论经非优势供血侧眶上锁孔入路显微手术治疗破裂前交通动脉瘤安全、有效。Objective To explore the clinical effect of microsurgical clipping via supraorbital keyhole approach of non-dominant feeder for ruptured anterior communicating artery aneurysms.Methods The clinical data of 69 patients with ruptured anterior communicating artery aneurysm who underwent microsurgery with supprorbital keyhole approach in the Second Affiliated Hospital of Soochow University from January 2016 to October 2020 were retrospectively analyzed.Among them,32 patients underwent non-dominant feeder approach and 37 patients underwent dominant feeder approach.The operation duration,the rate of intraoperative aneurysm rupture,the number of intraoperative aneurysm clips,the resection rate of frontal gyrus,the rate of incomplete aneurysm clipping,the variation and torsion rates of anterior communicating artery aneurysm complex,and the good prognosis rate were compared between the two groups.Results The operative time of the non-dominant feeder approach group and the dominant feeder approach group was(190±61)min and(204±55)min,respectively.Intraoperative aneurysm rupture occurred in 9 cases(24.3%)and 4 cases(12.5%)in the two groups,respectively.The number of intraoperative aneurysm clips were(1.38±0.61)and(1.35±0.63),the resection rate of frontal gyrus were 37.5%(12/32)and 48.6%(18/37),the rate of aneurysm occlusion was 3.1%(1/32)and 2.7%(1/37),and the variation and torsion rates of anterior communicating artery aneurysm complex were 16 cases(50.0%)and 14 cases(37.8%),respectively.The good prognosis rate of the two groups at discharge were 25(78.1%)and 28(75.7%),respectively,and the good prognosis rate at 1 month,3 months,6 months and 12 months after discharge were 25(78.1%)and 27(73.0%),respectively,with no statistical significance(all P>0.05).Conclusion Microsurgery through the supraorbital keyhole approach on the non-dominant feeder is safe and effective for the treatment of ruptured anterior communicating artery aneurysm.

关 键 词：前交通动脉 动脉瘤 锁孔手术入路 显微夹闭术 非优势供血 

分 类 号：R743.4[医药卫生—神经病学与精神病学] R739.41[医药卫生—临床医学]