CAJ | 학술논문

目的探讨颅内多发动脉瘤的手术策略并分析临床疗效.方法回顾性分析2009年1月至2013年12月手术治疗49例颅内多发动脉瘤患者的临床资料.49例患者中,男性12例,女性37例;平均年龄(49±11)岁;35例动脉瘤破裂,14例未破裂;治疗策略有一期手术(一侧入路夹闭所有动脉瘤),二期治疗(分期处理所有动脉瘤)和部分治疗(只处理责任动脉瘤).随访中复查脑CT血管造影(CTA)或数字减影血管造影(DSA),用格拉斯哥预后量表(GOS)评估预后.结果一期手术32例(65.3％),二期治疗9例(18.4％),部分治疗8例(16.3％).47例随访4 ～ 49个月,平均(22 ±7)个月.术后CTA或DSA均未见动脉瘤复发.根据GOS评分,患者预后良好(4～5分)41例(83.7％),残疾(2～3分)6例(12.2％),死亡(1分)2例(4.1％).结论在具有娴熟手术技术的前提下选择合适的患者,根据动脉瘤和患者的特征制定个性化的手术策略,能提高颅内多发动脉瘤的手术疗效.
목적 탐토로내다발동맥류적수술책략병분석림상료효.방법 회고성분석2009년1월지2013년12월수술치료49례로내다발동맥류환자적림상자료.49례환자중,남성12례,녀성37례;평균년령(49±11)세;35례동맥류파렬,14례미파렬;치료책략유일기수술(일측입로협폐소유동맥류),이기치료(분기처리소유동맥류)화부분치료(지처리책임동맥류).수방중복사뇌CT혈관조영(CTA)혹수자감영혈관조영(DSA),용격랍사가예후량표(GOS)평고예후.결과 일기수술32례(65.3％),이기치료9례(18.4％),부분치료8례(16.3％).47례수방4 ～ 49개월,평균(22 ±7)개월.술후CTA혹DSA균미견동맥류복발.근거GOS평분,환자예후량호(4～5분)41례(83.7％),잔질(2～3분)6례(12.2％),사망(1분)2례(4.1％).결론 재구유한숙수술기술적전제하선택합괄적환자,근거동맥류화환자적특정제정개성화적수술책략,능제고로내다발동맥류적수술료효.
Objective To discuss the surgical strategies and analyze the clinical outcomes of multiple intracranial aneurysms (MIA).Methods The clinical data of 49 MIA patients surgically treated between January 2009 and December 2013 was analyzed retrospectively.Among the 49 patients,12 patients were male and 37 were female,mean age(49 ± 11)years.Thirty-five patients had ruptured aneurysms,and 14 had unruptured aneurysms.Treatment strategies included one-stage operation (MIA were treated in one-stage with an unilateral approach),two-stage treatment (MIA were treated stage by stage) and partial treatment (only ruptured aneurysm was treated).Postoperative CT angiograms (CTA) or digital subtraction angiograms (DSA) were reviewed and the Glasgow Outcome Scale (GOS) scores were evaluated during follow-up period.Results Thirty-two patients (65.3％) underwent one-stage operation,9 patients (18.4％) underwent two-stage treatment,and 8 patients (16.3％) underwent partial treatment.Forty-seven patients were followed up 4-49 months,mean (22 ± 7) months.Postoperative CTA or DSA showed no aneurysm recurrence.According to the GOS scores,41 patients (83.7％) with good outcomes (GOS 4,5),6 patients (12.2％) were disabled (GOS 2,3) and 2 patients (4.1％) were dead (GOS 1).Conclusion Selecting the right patients for surgery and making personalized surgical strategies based on the characteristics of patients and aneurysms could improve the surgical outcomes of MIA.