CAJ | 학술논문

目的探讨前交通动脉瘤的手术疗效、手术时机与手术技巧.方法回顾性分析158例前交通动脉瘤手术过程与疗效.158例患者中合并其他部位的动脉瘤10例.均发生或曾经发生自发性蛛网膜下腔出血(SAH)(其中5例为非责任前交通动脉瘤),均行眶-翼点入路动脉瘤夹闭术.术前Hunt-Hess分级:Ⅰ级24例,Ⅱ级45例,Ⅲ级54例,Ⅳ级31例.Ⅴ级4例.手术时间在出血后3 d内者44例,4～14 d 74例,14 d以后40例.结果根据GOS疗效判断标准:恢复良好138例(87.34%),中残9例(5.69%),重残6例(3.80%),死亡5例(3.16%,包括家属放弃者).恢复良好的138例中Ⅰ级动脉瘤24例,Ⅱ级42例,Ⅲ级47例,Ⅳ级25例;其中3 d内手术者39例,4～14 d 64例,14 d以后35例.结论前交通动脉瘤的手术时机应依据患者的CT、DSA以及详细的神经系统检查等情况综合分析决定;眶-翼点入路有利于动脉瘤的显露;术前、术中、术后采取降低颅内压、脑保护以及3H治疗等一系列措施,有利于患者的预后.
목적 탐토전교통동맥류적수술료효、수술시궤여수술기교.방법 회고성분석158례전교통동맥류수술과정여료효.158례환자중합병기타부위적동맥류10례.균발생혹증경발생자발성주망막하강출혈(SAH)(기중5례위비책임전교통동맥류),균행광-익점입로동맥류협폐술.술전Hunt-Hess분급:Ⅰ급24례,Ⅱ급45례,Ⅲ급54례,Ⅳ급31례.Ⅴ급4례.수술시간재출혈후3 d내자44례,4～14 d 74례,14 d이후40례.결과 근거GOS료효판단표준:회복량호138례(87.34%),중잔9례(5.69%),중잔6례(3.80%),사망5례(3.16%,포괄가속방기자).회복량호적138례중Ⅰ급동맥류24례,Ⅱ급42례,Ⅲ급47례,Ⅳ급25례;기중3 d내수술자39례,4～14 d 64례,14 d이후35례.결론 전교통동맥류적수술시궤응의거환자적CT、DSA이급상세적신경계통검사등정황종합분석결정;광-익점입로유리우동맥류적현로;술전、술중、술후채취강저로내압、뇌보호이급3H치료등일계렬조시,유리우환자적예후.
Objective To explore the efficacy, operation timing and techniques of surgical treatment in patients with the anterior communicating aneurysms. Methods We retrospectively analyzed the surgical procedures and effectiveness of 158 patients with anterior communicating aneurysms. Ten of the 158 cases were combined with aneurysms in other branches. All patients had experienced SAH (5 cases were not relevant to anterior communicating aneurysm) and received incarceration of aneurysms through the orbit-pterion approach. Preoperative Hunt-Hess grade;the number of patients with grade Ⅰ,Ⅱ, Ⅲ,Ⅳ and Ⅴ were 24,45,54,31 and 4,respectively. Fourty-four cases received surgery within 3 days after SAH,74 cases within 4 to 14 days,and 40 cases after 14 days. Results According to GOS grade; 138 cases (87. 34% ) recovered with good outcome,9 cases (5.69%) with moderate disability, 6 cases (3.80%) with severe disability, and 5 death (3. 16%, including cases giving up treatment). Among the 138 patients having good outcomes,24 were grade Ⅰ ,42 grade Ⅱ ,47 grade Ⅲ and 25 grade Ⅳ. Thirty-nine cases underwent surgery within 3 days,64 within 3 to 14 days,and 35 after 14 days. Conclusion The surgical timing of anterior communicating aneurysms should be decided according to comprehensive analysis of CT, DSA, and detailed neurologic examination of the patients. Orbit pterion approach is favorable for exposing aneurysms. A series of actions,such as reducing intracranial pressure, cerebral protection and 3H therapy,will help to improve the prognosis of the patients .