CAJ | 학술논문

目的探讨经翼点入路手术夹闭前交通动脉动脉瘤的显微手术技巧.方法回顾性分析78例前交通动脉动脉瘤病人的临床资料.超早期手术64例,早期手术9例,延期手术5例.结果58例术前Hunt-Hess分级Ⅰ~Ⅲ级病人出院时GOS 4~5分50例,3分5例,2分1例,1分2例;20例Hunt-Hess Ⅳ~Ⅴ级病人出院时GOS 4~5分15例,3分2例,2分2例,1分1例.对62例患者随访6~12个月,无再出血,无死亡.结论早期手术夹闭前交通动脉动脉瘤能防止动脉瘤再次破裂;对于Hunt-Hess Ⅳ~Ⅴ级病人,在条件许可下行早期手术,仍可取得一定疗效;术中清除脑池内积血能减轻脑血管痉挛,改善患者预后.
목적탐토경익점입로수술협폐전교통동맥동맥류적현미수술기교.방법회고성분석78례전교통동맥동맥류병인적림상자료.초조기수술64례,조기수술9례,연기수술5례.결과58례술전Hunt-Hess분급Ⅰ~Ⅲ급병인출원시GOS 4~5분50례,3분5례,2분1례,1분2례;20례Hunt-Hess Ⅳ~Ⅴ급병인출원시GOS 4~5분15례,3분2례,2분2례,1분1례.대62례환자수방6~12개월,무재출혈,무사망.결론조기수술협폐전교통동맥동맥류능방지동맥류재차파렬;대우Hunt-Hess Ⅳ~Ⅴ급병인,재조건허가하행조기수술,잉가취득일정료효;술중청제뇌지내적혈능감경뇌혈관경련,개선환자예후.
Objective To investigate the skill of microsurgery through the pterional approach for the anterior communicating artery (ACoA) aneurysms. Methods The clinical data of 78 patients with ACoA aneurysms were analyzed retrospectively. Of 78 patients with ACoA aneurysms, 64 underwent microsurgery within 24 hours after the aneurysmal rupture, 9 from 24 to 72 hours and 5 more than 72 hours. Results Of 58 patients with preoperative Hunt-Hess grades Ⅰ~Ⅲ, 50 were recovered well (GOS 4~5 scores), 5 severely disabled (GOS 3 scores), 1 survived vegetatively (GOS 2 scores) and 2 died. Of 20 patients with preoperative Hunt-Hess grades Ⅳ~Ⅴ, 15 were recovered well, 2 severely disabled, 2 survived vegetatively and 1 died. Bleeding did not recurred and no patients died in 62 patients followed up from 6~12 months. Conclusions The reruptures of ACoA aneurysms may be prevented by microsurgery early after the aneurismal rupture, which may be performed also in the patients with Hunt-Hess grades Ⅳ~Ⅴ in whom the disease conditions permitted. Intraoperative clearance of the subarachnoid and intracisternal hemorrhage can reduce cerebral vasospasm and improve the prognosis in the patients with ACoA aneurysms.