CAJ | 학술논문

目的比较颅内破裂动脉瘤急性期和非急性期手术治疗的特点.方法对2008年12月至2010年12月浙江大学医学院附属第二医院神经外科收治的449例颅内破裂动脉瘤手术病例进行分析.比较急性期手术组与非急性期手术组在术前破裂风险、完全夹闭率、术后并发症发生率以及预后的差异.结果两组相比,非急性期手术组术前再破裂风险明显升高,差异有统计学意义；术中完全夹闭率、术后并发症发生率及预后差异无统计学意义.亚组分析中,Hunt - Hess Ⅰ ～Ⅲ级亚组间术前再破裂风险差异有统计学意义,其他同级别亚组间完全夹闭率、并发症发生率、及预后差异无统计学意义.结论急性期手术可以明显减少术前再次出血,尤其是Hunt - Hess评分Ⅰ～Ⅲ级的患者可通过急性期手术减低因术前出血引起的死亡致残风险.
목적 비교로내파렬동맥류급성기화비급성기수술치료적특점.방법 대2008년12월지2010년12월절강대학의학원부속제이의원신경외과수치적449례로내파렬동맥류수술병례진행분석.비교급성기수술조여비급성기수술조재술전파렬풍험、완전협폐솔、술후병발증발생솔이급예후적차이.결과 량조상비,비급성기수술조술전재파렬풍험명현승고,차이유통계학의의；술중완전협폐솔、술후병발증발생솔급예후차이무통계학의의.아조분석중,Hunt - Hess Ⅰ ～Ⅲ급아조간술전재파렬풍험차이유통계학의의,기타동급별아조간완전협폐솔、병발증발생솔、급예후차이무통계학의의.결론 급성기수술가이명현감소술전재차출혈,우기시Hunt - Hess평분Ⅰ～Ⅲ급적환자가통과급성기수술감저인술전출혈인기적사망치잔풍험.
Objective To study the advantages and disadvantages of aneurysm surgery with different timing in a two -year period.Methods This study examined 449 patients with ruptured intracranial aneurysms treated surgically between Dec 2008 and Dec 2010 in Department of Neurosurgery,2nd affiliated hospital of Zhejiang University Medical Institute.Early aneurysm surgery was defined as operation performed within 72 hours after onset of subarachnoid haemorrhage; non - early surgery as performed after 72 hours.Muhiple factors,including the incidence of pre -operative rebleeding,incidence of complete occlusion of the ruptured aneurysm and incidence of major complications such as cerebral infarction and hydrocephalus,were analyzed.Surgical outcomes after 3 months were assessed using the Glasgow outcome score (GOS).Survival analysis was used to analyze 3 months follow - up date with outcome events as death,cerebral infarction or hydrocephalus. Patients were categorize into 2 subgroups grading by the Hunt - Hess classification,that was,one subgroup of patients with Hunt - Hess grades Ⅰ,Ⅱ and Ⅲ and the other subgroup of patients with grades Ⅳ and Ⅴ Multiple factors of the two subgroups were analyzed.Results 50.1％ of cases fell into the early surgery group and 49.9％ into the non - early operated group.There was a lower rate of pre - operative rebleeding in the early surgery group (5.36％ versus 1.33％,P ＜ 0.05 ).The incidence of complete occlusion of the ruptured aneurysm and the incidence of major complications showed no significant difference between these 2 groups.There was no significant difference in GOS between the early surgery group and the non - early surgery group at 3 months.In the subgroup of patients with Hunt - Hess grades Ⅰ,Ⅱ and Ⅲ,there was a lower rate of pre - operative rebleeding in the early surgery group ( 3.98 versus 0.4.9％,P ＜ 0.05 ) and there was no significant difference in other factors.In the subgroup of patients with Hunt - Hess grades Ⅳ and Ⅴ,there was no significant difference in all factors.Conclusions Early operation,especially for the patients with Hunt - Hess grades Ⅰ,Ⅱ and Ⅲ,can significantly reduce the rebleeding before surgery.The timing of surgery do not significantly affect incidence of surgical complications and surgical outcomes.