CAJ | 학술논문

目的：探讨合并眼部症状的颅内动脉瘤的临床特点和治疗效果。方法回顾性分析我科近四年间收治的73例合并眼部症状的颅内动脉瘤病例。所有患者均经DSA或CTA检查明确诊断后施行动脉瘤瘤颈夹闭手术或介入栓塞治疗，重点分析动脉瘤的位置、大小及瘤顶指向与眼部症状的关系，随访观察术后眼部症状改善情况。结果73例合并眼部症状的动脉瘤患者中表现为颅神经麻痹58例，视力下降37例，眼痛34例，视野改变9例，眼底改变11例。43例经动脉瘤颈夹闭手术治疗的患者，术后症状消失或有较大程度改善的24例，占55．8％。30例经介入栓塞治疗的患者，术后症状消失或有较大程度改善8例，占26．7％。动脉瘤瘤颈夹闭手术治疗组眼部症状疗效优于介入栓塞治疗组（ P＜0．01）。结论近半数颅内动脉瘤伴有眼部临床表现，其中以颈内动脉海绵窦段、眼动脉段和后交通动脉段动脉瘤最多见。眼部症状以动眼神经麻痹最为常见，及时发现以眼部表现为首发症状的动脉瘤，对改善患者预后意义重大。就眼部症状治疗效果而言，动脉瘤瘤颈夹闭手术优于介入栓塞治疗。
목적：탐토합병안부증상적로내동맥류적림상특점화치료효과。방법회고성분석아과근사년간수치적73례합병안부증상적로내동맥류병례。소유환자균경DSA혹CTA검사명학진단후시행동맥류류경협폐수술혹개입전새치료，중점분석동맥류적위치、대소급류정지향여안부증상적관계，수방관찰술후안부증상개선정황。결과73례합병안부증상적동맥류환자중표현위로신경마비58례，시력하강37례，안통34례，시야개변9례，안저개변11례。43례경동맥류경협폐수술치료적환자，술후증상소실혹유교대정도개선적24례，점55．8％。30례경개입전새치료적환자，술후증상소실혹유교대정도개선8례，점26．7％。동맥류류경협폐수술치료조안부증상료효우우개입전새치료조（ P＜0．01）。결론근반수로내동맥류반유안부림상표현，기중이경내동맥해면두단、안동맥단화후교통동맥단동맥류최다견。안부증상이동안신경마비최위상견，급시발현이안부표현위수발증상적동맥류，대개선환자예후의의중대。취안부증상치료효과이언，동맥류류경협폐수술우우개입전새치료。
Objective To investigate the clinical characteristics and prognosis of intracranial aneurysm with ophthalmic changes .Methods The clinical data of 73 patients with intracranial aneurysm caused ophthalmic changes in our hospital within recent four years were analyzed retrospectively .All patients were diagnosed by digital subtraction angiography ( DSA ) or computed tomography angiography (CTA) and treated by microsurgical clipping or interventional embolization . Different locations sizes of aneurysms and pointing of its tips , situation of ophthalmic changes were analyzed .The improvement of ophthalmic changes after operation were followed up .Results 73 patients (44.5%) had ophthalmic changes in 164 patients.58 patients suffered from cranial nerve palsy, visual diminished in 37 cases, 34 patients had eyeball and orbital pain , 11 cases had fundus changes and 9 cases had visual field defects .43 patients with ophthalmic changes were treated by microsurgical clipping , 24 patients showed complete or partly recovery after operation (55.8%).30 patients with ophthalmic changes were treated by interventional embolization , only 8 showed complete or partly recovery after operation ( 26.7%). Microsurgical clipping treatment was superior to interventional embolization for the improvement of ophthalmic changes .Conclusions Half of intracranial aneurysms patients had ophthalmic changes , and the oculomotor nerve palsy was the most common change .Early diagnosis and treatment can make better outcome .Microsurgical clipping treatment is superior to interventional embolization for the improvement of ophthalmic changes .