CAJ | 학술논문

目的比较颅内前循环动脉瘤破裂中、晚期显微手术夹闭的疗效并探讨中期治疗(4-10 d)的可行性.方法回顾性分析了95例前循环动脉瘤破裂出血后4-10 d入院,且入院时Hunt-Hess分级Ⅰ～Ⅲ的患者,41例接受中期动脉瘤手术夹闭,54例接受晚期手术夹闭(11-30 d),以改良Rankin量表评分对患者预后进行评分.结果出院后6个月,中期组30例(73.2%)患者预后良好(mRS 0～2级),而晚期组为42例(77.8%),两组差异无统计学意义.导致预后不良的最主要原因为动脉瘤破裂再出血.结论颅内前循环动脉瘤破裂中期,积极闭塞动脉瘤可为患者获得良好的预后创造条件,尤其是临床状况良好的患者.
목적 비교로내전순배동맥류파렬중、만기현미수술협폐적료효병탐토중기치료(4-10 d)적가행성.방법 회고성분석료95례전순배동맥류파렬출혈후4-10 d입원,차입원시Hunt-Hess분급Ⅰ～Ⅲ적환자,41례접수중기동맥류수술협폐,54례접수만기수술협폐(11-30 d),이개량Rankin량표평분대환자예후진행평분.결과 출원후6개월,중기조30례(73.2%)환자예후량호(mRS 0～2급),이만기조위42례(77.8%),량조차이무통계학의의.도치예후불량적최주요원인위동맥류파렬재출혈.결론 로내전순배동맥류파렬중기,적겁폐새동맥류가위환자획득량호적예후창조조건,우기시림상상황량호적환자.
Objective To compare the effect of microsurgery for ruptured intracranial supratentorial uneurysms during intermediate period versus delayed period and to evaluate the feasibility of surgical clipping during intermediate period. Method A retrospective analysis of 95 patients with Hunt-Hess Grade Ⅰ～Ⅲ on admission who were admitted 4 to 10 days after initial supratentorial aneurysmal subarachnoid haemorrhage. Forty-one patients underwent intermediate clipping while 54 patients accepted delayed obliteration of ruptured aneurysm (days 11-30). Outcome after 6 months was assessed using Modified Rankin Scale(mRS). Results There was no difference in outcome between two groups according to mRS at 6 months follow-up. Thirty patients(73.2%) in the intermediate group and 42 patients(77.8%) in the late group had a favorable functional outcome with a mRS score of 0 to 2. In 39.1% of the 23 patients who had poor outcome, rebleeding before active treatment was the leading factor contributing to poor outcome. Conclusions Surgical clipping of ruptured intracranial aneurysms during intermediate period provided good opportunity for patients to achieve favorable outcomes especially for those in good clinical condition.