CAJ | 학술논문

目的：对比评价前上指向前交通动脉瘤采用A2平面开放侧与闭合侧翼点入路治疗的手术难度、安全性与疗效，指导翼点入路的侧别选择。方法回顾性分析42例采用手术夹闭的前上指向前交通动脉瘤患者的临床资料和影像学资料，分为A2平面开放侧翼点入路组22例及A2平面闭合侧翼点入路组(对照组)20例。对比分析两组的直回切除率，同侧A2移位率，手术并发症发生率，夹闭效果，术后6个月认知障碍发生率和格拉斯哥预后评分(Glasgow Outcome Scale，GOS)等。结果直回切除及同侧A2移位率A2平面开放侧翼点入路组(4/22)较对照组（11/20）低(χ2=6.185，P<0.05），术后6个月认知障碍发生率A2平面开放侧翼点入路组(4/22)较对照组（10/20）低(χ2=4.773，P<0.05），手术并发症发生率A2平面开放侧翼点入路组(1/22)也较对照组(7/20)低(χ2=4.481，P<0.05)。术后夹闭效果和术后6个月GOS等两组间比较均无明显统计学意义(P>0.05)。结论前上指向前交通动脉瘤采用A2平面开放侧翼点入路可降低手术难度、利于瘤颈保护和预防手术并发症。
목적：대비평개전상지향전교통동맥류채용A2평면개방측여폐합측익점입로치료적수술난도、안전성여료효，지도익점입로적측별선택。방법회고성분석42례채용수술협폐적전상지향전교통동맥류환자적림상자료화영상학자료，분위A2평면개방측익점입로조22례급A2평면폐합측익점입로조(대조조)20례。대비분석량조적직회절제솔，동측A2이위솔，수술병발증발생솔，협폐효과，술후6개월인지장애발생솔화격랍사가예후평분(Glasgow Outcome Scale，GOS)등。결과직회절제급동측A2이위솔A2평면개방측익점입로조(4/22)교대조조（11/20）저(χ2=6.185，P<0.05），술후6개월인지장애발생솔A2평면개방측익점입로조(4/22)교대조조（10/20）저(χ2=4.773，P<0.05），수술병발증발생솔A2평면개방측익점입로조(1/22)야교대조조(7/20)저(χ2=4.481，P<0.05)。술후협폐효과화술후6개월GOS등량조간비교균무명현통계학의의(P>0.05)。결론전상지향전교통동맥류채용A2평면개방측익점입로가강저수술난도、리우류경보호화예방수술병발증。
Objective To investigate the difficulty, safety and clinical efficacy of the pterional approach from the side of open A2 plane vs the approach from the side of closed A2 plane for anterosuperior-pointing anterior communicat?ing artery aneurysms (ACoAA). Methods Forty-two patients with anterosuperior-pointing ACoAA treated by microsurgi?cal clipping were divided into two groups of the approach from the side of open A2 plane (n=22) and the approach from the side of closed A2 plane (n=20). Primary objective endpoints were rates of gyrus rectus aspiration, displacement of the ipsilateral A2 and surgical-related complications, clipping results, incidence of cognitive function impairment and Glasgow Outcome Scale (GOS) at 6 months after treatment. Results The incidence of gyrus rectus aspiration and dis?placement of the ipsilateral A2, cognitive impairment at 6 months after treatment and the surgical-related complications was also significant lower in the approach from the side of open A2 plane than in the approach from the side of closed A2 plane [4(18.2%) cases vs. 11(55.0%) cases, χ2=6.185, P<0.05;4(18.2%) cases vs. 10(50.0%) cases, χ2=4.773, P<0.05;1 (4.5%) case vs. 7(35.0%) cases, χ2=4.481 P<0.05]. There were no significant differences in postoperative clipping results and GOS at 6 months after treatment between two approaches (P>0.05). Conclusions The pterional approach from the side of open A2 plane in patients with anterosuperior-pointing ACoAA allows the aneurysmal necks to be secured safely, decreases operation difficulty and prevents surgical-related complications.