CAJ | 학술논문

目的探讨颅内动脉瘤破裂并颅内血肿形成患者行早期显微外科手术治疗的临床疗效. 方法梅州市人民医院神经外科自2009年1月至2013年1月共收治32例颅内动脉瘤破裂并颅内血肿形成患者,其中男18例,女14例;年龄32～78岁,平均55岁;均以突发头痛、呕吐、意识障碍为首发症状;Hunt-Hess分级Ⅲ级7例,Ⅳ级20例,Ⅴ级5例;术前头颅CT表现为颅内血肿伴或不伴蛛网膜下腔出血,血肿量均大于20 mL;CT血管成像(CTA)检查或术中证实为颅内动脉瘤破裂出血,其中前交通动脉瘤7例,后交通动脉瘤3例,颈内动脉瘤7例,大脑中动脉瘤13例,多发动脉瘤2例;均在发病后72 h内行血肿清除、动脉瘤夹闭,其中19例伴脑室内积血、急性梗阻性脑积水者在动脉瘤夹闭前行脑室外引流术,19例行去除骨瓣减压术. 结果 32例患者术后随访3个月～2年,GOS预后分级为5级(恢复良好)6例,4级(生活自理)12例,3级(重残)11例,2级(植物生存)0例,1级(死亡)2例,1例术后放弃进一步治疗;术前Hunt-Hess分级Ⅲ级的恢复满意率(84.6％)明显高于Hunt-Hess分级Ⅳ～Ⅴ级的恢复满意率(36.8％),差异有统计学意义(P＜0.05). 结论对于颅内动脉瘤破裂并颅内血肿形成患者,早期行显微外科手术清除血肿并夹闭动脉瘤可获得较满意的临床疗效.
목적 탐토로내동맥류파렬병로내혈종형성환자행조기현미외과수술치료적림상료효. 방법 매주시인민의원신경외과자2009년1월지2013년1월공수치32례로내동맥류파렬병로내혈종형성환자,기중남18례,녀14례;년령32～78세,평균55세;균이돌발두통、구토、의식장애위수발증상;Hunt-Hess분급Ⅲ급7례,Ⅳ급20례,Ⅴ급5례;술전두로CT표현위로내혈종반혹불반주망막하강출혈,혈종량균대우20 mL;CT혈관성상(CTA)검사혹술중증실위로내동맥류파렬출혈,기중전교통동맥류7례,후교통동맥류3례,경내동맥류7례,대뇌중동맥류13례,다발동맥류2례;균재발병후72 h내행혈종청제、동맥류협폐,기중19례반뇌실내적혈、급성경조성뇌적수자재동맥류협폐전행뇌실외인류술,19례행거제골판감압술. 결과 32례환자술후수방3개월～2년,GOS예후분급위5급(회복량호)6례,4급(생활자리)12례,3급(중잔)11례,2급(식물생존)0례,1급(사망)2례,1례술후방기진일보치료;술전Hunt-Hess분급Ⅲ급적회복만의솔(84.6％)명현고우Hunt-Hess분급Ⅳ～Ⅴ급적회복만의솔(36.8％),차이유통계학의의(P＜0.05). 결론 대우로내동맥류파렬병로내혈종형성환자,조기행현미외과수술청제혈종병협폐동맥류가획득교만의적림상료효.
Objective To investigate the microsurgical managements of intracranial ruptured aneurysms combined with intracranial hematomas and to observe their therapeutic efficacy.Methods A total of 32 patients with intracranial ruptured aneurysms combined with intracranial hematomas,treated in our hospital from January 2009 to January 2013,were chosen in our study;18 male and 14 female patients ranged from 32 to 78 years old (mean age of 55 years) were enrolled,with sudden headache,vomiting,disturbance of consciousness as the first symptoms.The preoperative status on admission was Hunt-Hess grade Ⅲ in 7,grade Ⅳ in 20 and grade Ⅴ in 5.Radiographic imaging demonstrated 7 anterior communicating artery aneurysms,3 posterior communicating artery aneurysms,7 internal carotid artery aneurysms,13 middle cerebral artery aneurysms and 2 multiple aneurysms.The associated hematoma was greater than 20 mL.All patients were brought emergently to the operating room and treated with aneurysm clipping within 72 h.Decompressive craniectomy was performed in 19 patients,and external ventricular drainage was performed in 19 patients.Results Postoperative follow up (ranged from 3-24 months) showed good recovery,moderate recovery,severe disability,persistent vegetative state and death in 6,12,11,0 and 2,respectively,graded by Glasgow Outcome Scale;the remaining one patient was lost to follow-up.The percentage of good prognosis in patients with preoperative Hunt-Hess grade of Ⅲ grade (84.6％) was higher than that of patients with Ⅳ-Ⅴ grade (36.8％,P＜0.05).Conclusions Early evacuation of space-occupying hematoma,aneurysm clipping and emergent decompessive cranioctomy could lead to survival with good recovery in some patients.