CAJ | 학술논문

目的：探讨颅内前循环动脉瘤夹闭术中动脉瘤破裂（IAR）的不同破裂点（瘤体、瘤颈及瘤顶）对患者手术预后的影响。方法对2009年5月—2012年3月连续纳入的135例（148个动脉瘤）接受显微动脉瘤夹闭术患者的临床资料进行回顾性分析，对术后患者的预后评价采用格拉斯哥预后量表（GOS）进行评定。将发生IAR动脉瘤的不同破裂点作为影响因素，并对其与IAR患者不同预后之间的关系进行分析。结果135例患者的148个动脉瘤夹闭术中，30例患者的31个动脉瘤发生术中破裂（占动脉瘤20.9％，占患者22.2％），其中破裂点发生在动脉瘤顶部9个、体部17个及颈部5个。17例患者GOS评分5分，8例4分，2例3分，1例2分，2例1分；预后良好者共25例，预后不良者共5例。IAR不同破裂点对于 IAR患者预后的影响差异有统计学意义（OR＝1.273，95％CI：6.764～18.344，P＝0.006），其中25例瘤体、顶部破裂者中1例预后不良，5例瘤颈部破裂者中4例预后不良。结论前循环动脉瘤夹闭术中动脉瘤破裂点对于IAR患者预后可产生明显影响，其中瘤颈部破裂是导致患者不良预后的主要因素。
목적：탐토로내전순배동맥류협폐술중동맥류파렬（IAR）적불동파렬점（류체、류경급류정）대환자수술예후적영향。방법대2009년5월—2012년3월련속납입적135례（148개동맥류）접수현미동맥류협폐술환자적림상자료진행회고성분석，대술후환자적예후평개채용격랍사가예후량표（GOS）진행평정。장발생IAR동맥류적불동파렬점작위영향인소，병대기여IAR환자불동예후지간적관계진행분석。결과135례환자적148개동맥류협폐술중，30례환자적31개동맥류발생술중파렬（점동맥류20.9％，점환자22.2％），기중파렬점발생재동맥류정부9개、체부17개급경부5개。17례환자GOS평분5분，8례4분，2례3분，1례2분，2례1분；예후량호자공25례，예후불량자공5례。IAR불동파렬점대우 IAR환자예후적영향차이유통계학의의（OR＝1.273，95％CI：6.764～18.344，P＝0.006），기중25례류체、정부파렬자중1례예후불량，5례류경부파렬자중4례예후불량。결론전순배동맥류협폐술중동맥류파렬점대우IAR환자예후가산생명현영향，기중류경부파렬시도치환자불량예후적주요인소。
Objective Toinvestigatetheimpactofthedifferentrupturepoints(sac,neck,andtop) of intraoperative aneurysm rupture (IAR)on the prognosis of patients in anterior circulation aneurysm clipping.Methods Theclinicaldataof135consecutivepatients(148aneurysms)acceptedmicrosurgical aneurysm clipping from May 2009 to March 2012 were analyzed retrospectively. The prognostic evaluation of the patients after procedure was assessed by using the Glasgow outcome scale (GOS). The different aneurysm rupture points of IAR were used as influencing factors,and the relationship between the different rupture pointsandtheprognosisofpatientswasanalyzed.Results Duringclippingof148aneurysmsin 135 patients,31 aneurysms in 30 patients had intraoperative rupture (20. 9% of the aneurysms, 22.2% of the patients). Nine rupture points occurred on the top of aneurysms,17 occurred on the sac,and 5 occurred on neck. The Glasgow outcome scale (GOS)scores 5,4,3,2 and 1 were in 17,8,2,1 and 2 patients,respectively. A total of 25 patients had good prognosis and 5 cases had poor prognosis. There were no significant differences in the impact of different rupture points of IAR on the prognosis in patients of IAR (OR,100. 00,95% confidence interval 6. 764-18. 344,P=0. 006). Of the 25 patients with aneurysm sac or top rupture,1 case had poor prognosis. Of the 5 patients with aneurysm neck rupture, 4caseshadpoorprognosis.Conclusion Inanteriorcirculationaneurysmclipping,thedifferent aneurysm rupture points may have significant impact on the prognosis of patients,the aneurysm neck rupture is a main factor for resulting in the poor prognosis of patients.