【摘要】 目的探讨显微手术治疗颅内巨大动脉瘤的技巧和预后。方法回顾性分析经显微手术治疗的80例颅内巨大动脉瘤患者的临床资料,其中包括77例行瘤颈夹闭术、2例行动脉瘤孤立术、1例行血管旁路移植合并动脉瘤切除术。术后均常规进行吲哚菁绿术中荧光造影监测手术结果。从Hunt-Hess分级、不同部位动脉瘤及不同手术时机三个方面观察预后,以格拉斯哥预后评分(GOS)评估预后。结果全组80例中,出院时GOS评分良好67例(83.8%),差9例(11.2%),死亡4例(5.0%)。①Hunt-Hess 0～Ⅲ级的73例中,良好65例(89.0%);Hunt-HessⅣ级的7例中,良好的仅2例(28.6%)。两者差异有统计学意义,校正χ~2=13.006,P<0.001。②后交通动脉动脉瘤和大脑中动脉瘤良好率分别为92.8%(13/14)和91.7%(11/12);床突旁动脉瘤和椎-基底动脉瘤良好率为60%～70%。由于各组例数不多,总比较差异无统计学意义,χ~2=5.599,P>0.05。③在56例蛛网膜下腔出血的患者中,手术时机≤3 d者良好率低于>3d者,差异有统计学意义。χ~2=9.088,P<0.05。结论①术中更充分地暴露、近端载瘤动脉的临时阻断、调整瘤夹以对瘤颈良好塑形、做好必要时血管旁路移植术的准备,是颅内巨大动脉瘤手术成功关键。②手术疗效与Hunt-Hess分级和手术时机相关。③不同部位动脉瘤因样本量有限,未显示与手术效果相关。更多还原

【Abstract】 Objective To investigate the skills and efficacy of microsurgery in the treatment of giant intracranial aneurysms.Methods The clinical data of 80 patients with giant intracranial aneurysms treated with microsurgery were analyzed retrospectively,77 of them underwent performed aneurysm neck clipping,2 aneurysms were isolated,and 1 had vascular bypass graft and aneurysm resection.The results were monitored routinely with intra-operative indocyanine green angiography after the procedures.The prognosis was observed on the basis of the Hunt-Hess grading,the different location of aneurysms,and the timings of operation,and assessed according to the Glasgow outcome scale ( GOS ) .Results Of the 80 patients,67 (83.8%) had good GOS score,9 ( 11.2 %) had poor GOS score at discharge and 4(5% ) died.①Of the 73 patients with Hunt-Hess grade O - Ⅲ,65 (89.0% ) had good prognosis.Of the 7 patients with Hunt-Hess grade IV only 2 had good prognosis.There was significant difference (χ~2 = 13.006,P < 0.001).②The rates of good result of posterior communicating artery aneurysms,middle cerebral aneurysms,paraclinoid aneurysms and vertebral - basilar artery aneurysms were 92.8% ,91.7% ,60% and 70% respectively;In view of the number of cases is few in each group,there were no significant differences in comparison (χ~2 =5.599 ,P >0.05).③In 56 patients with subarachnoid hemorrhage,the rate of good result was higher in patients whose surgery timing was >3 days as compared with≤3 days.There was significant difference (χ~2 =9.088,P < 0.05).Conclusion The key to successful operation for giant intracranial aneurysm is sufficient operative exposure,temporary occlusion of the parent artery,adjust the aneurysm clips for good remodeling of the aneurysmal neck,and making preparations for vascular bypass graft if necessary. The surgical efficacy is associated with the Hunt-Hess grading and the timing of surgery.更多还原