国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
3期
188-193
,共6页
焦风%王栋梁%刘波%梁冶矢%张庆俊
焦風%王棟樑%劉波%樑冶矢%張慶俊
초풍%왕동량%류파%량야시%장경준
颅内动脉瘤%神经外科手术%治疗结果%危险因素
顱內動脈瘤%神經外科手術%治療結果%危險因素
로내동맥류%신경외과수술%치료결과%위험인소
Intracranial Aneurysm%Neurosurgical Procedures%Treatment Outcome%Risk Factors
目的 探讨复杂型后交通动脉(posterior communicating artery,PCoA)动脉瘤的临床特点和显微外科夹闭治疗的转归.方法 回顾性分析经开颅显微外科夹闭治疗的PCoA动脉瘤患者的临床和影像学资料,根据其是否存在手术夹闭治疗的复杂因素将其分为复杂型组和简单型组.根据格拉斯哥转归量表评分将患者分为转归良好组和转归不良组.结果 共纳入55例PCoA动脉瘤患者,其中17例(30.9％)为简单型,38例(69.1％)为复杂型.简单型组Fisher分级较高的患者比例显著性低于复杂型组(Z=-2.068,P=0.019),但两组年龄、性别、术前破裂、Hunt-Hess分级的构成比无显著性差异(P均＞0.05).在复杂型组中,复杂夹闭(73.68％)和前床突切除(42.11％)是最常见的复杂因素,24例(63.16％)存在多个复杂因素.在复杂型病例中,32例转归良好,6例转归不良(其中3例死亡);在简单型病例中,15例转归良好,2例转归不良(其中1例死亡);复杂型组转归良好率与简单型组无显著性差异(84.21％对88.24％x2 =0.153,P=0.696).55例PCoA患者中,转归良好组年龄显著性低于转归不良组[(58.23±12.41)岁对(68.38 ±8.68)岁;t=-2.212,P=0.031],而性别、Fisher分级、Hunt-Hess分级、手术复杂性因素以及手术夹闭程度均无显著性差异(P均＞0.05).多变量logisitc回归分析显示,仅年龄是PCoA动脉瘤转归不良的独立危险因素(优势比1.142,95％可信区间1.029 ～1.266;P =0.012).结论 采用先进的显微外科技术,如前床突切除、脉络膜前动脉显微分离、复杂夹闭等治疗复杂型PCoA动脉瘤的效果并不逊于简单型,而年龄是PCoA动脉瘤转归不良的独立危险因素.
目的 探討複雜型後交通動脈(posterior communicating artery,PCoA)動脈瘤的臨床特點和顯微外科夾閉治療的轉歸.方法 迴顧性分析經開顱顯微外科夾閉治療的PCoA動脈瘤患者的臨床和影像學資料,根據其是否存在手術夾閉治療的複雜因素將其分為複雜型組和簡單型組.根據格拉斯哥轉歸量錶評分將患者分為轉歸良好組和轉歸不良組.結果 共納入55例PCoA動脈瘤患者,其中17例(30.9％)為簡單型,38例(69.1％)為複雜型.簡單型組Fisher分級較高的患者比例顯著性低于複雜型組(Z=-2.068,P=0.019),但兩組年齡、性彆、術前破裂、Hunt-Hess分級的構成比無顯著性差異(P均＞0.05).在複雜型組中,複雜夾閉(73.68％)和前床突切除(42.11％)是最常見的複雜因素,24例(63.16％)存在多箇複雜因素.在複雜型病例中,32例轉歸良好,6例轉歸不良(其中3例死亡);在簡單型病例中,15例轉歸良好,2例轉歸不良(其中1例死亡);複雜型組轉歸良好率與簡單型組無顯著性差異(84.21％對88.24％x2 =0.153,P=0.696).55例PCoA患者中,轉歸良好組年齡顯著性低于轉歸不良組[(58.23±12.41)歲對(68.38 ±8.68)歲;t=-2.212,P=0.031],而性彆、Fisher分級、Hunt-Hess分級、手術複雜性因素以及手術夾閉程度均無顯著性差異(P均＞0.05).多變量logisitc迴歸分析顯示,僅年齡是PCoA動脈瘤轉歸不良的獨立危險因素(優勢比1.142,95％可信區間1.029 ～1.266;P =0.012).結論 採用先進的顯微外科技術,如前床突切除、脈絡膜前動脈顯微分離、複雜夾閉等治療複雜型PCoA動脈瘤的效果併不遜于簡單型,而年齡是PCoA動脈瘤轉歸不良的獨立危險因素.
목적 탐토복잡형후교통동맥(posterior communicating artery,PCoA)동맥류적림상특점화현미외과협폐치료적전귀.방법 회고성분석경개로현미외과협폐치료적PCoA동맥류환자적림상화영상학자료,근거기시부존재수술협폐치료적복잡인소장기분위복잡형조화간단형조.근거격랍사가전귀량표평분장환자분위전귀량호조화전귀불량조.결과 공납입55례PCoA동맥류환자,기중17례(30.9％)위간단형,38례(69.1％)위복잡형.간단형조Fisher분급교고적환자비례현저성저우복잡형조(Z=-2.068,P=0.019),단량조년령、성별、술전파렬、Hunt-Hess분급적구성비무현저성차이(P균＞0.05).재복잡형조중,복잡협폐(73.68％)화전상돌절제(42.11％)시최상견적복잡인소,24례(63.16％)존재다개복잡인소.재복잡형병례중,32례전귀량호,6례전귀불량(기중3례사망);재간단형병례중,15례전귀량호,2례전귀불량(기중1례사망);복잡형조전귀량호솔여간단형조무현저성차이(84.21％대88.24％x2 =0.153,P=0.696).55례PCoA환자중,전귀량호조년령현저성저우전귀불량조[(58.23±12.41)세대(68.38 ±8.68)세;t=-2.212,P=0.031],이성별、Fisher분급、Hunt-Hess분급、수술복잡성인소이급수술협폐정도균무현저성차이(P균＞0.05).다변량logisitc회귀분석현시,부년령시PCoA동맥류전귀불량적독립위험인소(우세비1.142,95％가신구간1.029 ～1.266;P =0.012).결론 채용선진적현미외과기술,여전상돌절제、맥락막전동맥현미분리、복잡협폐등치료복잡형PCoA동맥류적효과병불손우간단형,이년령시PCoA동맥류전귀불량적독립위험인소.
Objective To investigate the clinical features of complex posterior communicating artery aneurysms and the outcome of microsurgical clipping.Methods The clinical and imaging data of the patients with posterior communicating artery aneurysm treated by craniotomy microsurgical clipping were analyzed retrospectively.The patients were divided into either a complex type group or a simple type group according to whether they had complex factors of surgical clipping or not.They were divided into a good outcome group and a poor outcome group according to their Glasgow Outcome Scale scores.Results A total of 55 patients with posterior communicating artery aneurysm were enrolled,and 17 (30.9％) of them were in the simple type group and 38 (69.1％) were in the complex type group.The proportion of higher Fisher grade in the patients of the simple type group was significantly lower than that of the complex type group (Z =-2.068,P=0.019).However,there were no significant differences in the proportions of age,sex,preoperative rupture,and Hunt-Hess grade between the two groups (all P ＞ 0.05).In the complex type group,the complex clipping (73.68％) and anterior clinoidectomy (42.11％) were the most common complex factors.Twenty-four patients (63.16％) had a number of complex factors.In the complex type cases,32 had good outcome,6 had poor outcome (3 of them died); in the simple type cases,15 had good outcome,2 had poor outcome (1 of them died).There was no significant difference in the good outcome rate between the complex type group and the simple type group (84.21％ vs.88.24％;x2 =0.153,P=0.696).In 55 patients with posterior communicating artery aneurysm,the age of the good outcome group was significantly lower than that of the poor outcome group (58.23 ± 12.41 years vs.68.38 ± 8.68 years,t =-2.212; P =0.031),and there were no significant differences in sex,Fisher grade,Hunt-Hess grade,factors of surgical complexity,and surgical clipping level (all P ＞ 0.05).Multivariate logistic regression analysis showed that only age was the independent risk factor for poor outcome of the complex posterior communicating artery aneurysm (odds ratio 1.142,95％ confidence interval 1.029-1.266; P =0.012).Conclusions Using the advanced microsurgical techniques,such as anterior clinoidectomy,anterior choroidal artery microdissection,and complex clipping for the treatment of complex posterior communicating artery aneurysm are no less favorable than the simple type,and age is an independent risk factor for the poor outcome of posterior communicating artery aneurysm.
