【摘要】 目的 探討開顱手術(shù)夾閉顱內(nèi)前循環(huán)動(dòng)脈瘤破裂的方法和療效。 方法 回顧分析2005年1月-2008年1月28例前循環(huán)動(dòng)脈瘤破裂的早期外科手術(shù)治療情況。分析其臨床表現(xiàn)、手術(shù)入路和預(yù)后，用格拉斯哥術(shù)后評(píng)分量表對(duì)術(shù)后患者神經(jīng)功能評(píng)分。 結(jié)果 28例患者共30個(gè)動(dòng)脈瘤，手術(shù)成功夾閉28個(gè)，包裹2個(gè)。術(shù)后3個(gè)月內(nèi)，患者恢復(fù)良好15例（53.57%），中度病殘7例（25.00%），重度病殘5例（17.86%），死亡1例（3.57%）。 結(jié)論 早期開顱手術(shù)夾閉動(dòng)脈瘤能減少再出血率和術(shù)前死亡率，術(shù)后預(yù)后較好，是治療前循環(huán)動(dòng)脈瘤破裂較為理想的方法。
【Abstract】 Objective To investigate the clinical strategy and effect of early phase surgery for ruptured cerebral anterior circulating aneurysm. Methods A retrospective analysis was done for 28 patients with ruptured anterior circulating aneurysms who underwent early phase (within 3 days) surgical clipping from January 2005 to January 2008. Their manifestations, surgical approach, and outcomes were analyzed. Glasgow outcome scale (GOS) was used to evaluate patients’ neurological function after operation. Results Among 30 intracranial aneurysms in 28 patients, 28 aneurysms were clipped successfully, and the other 2 were wrapped. One patient (3.57%) died after surgery. The follow-up data showed an excellent outcome was achieved in 15 cases, mild disability in 7 cases, and severe disability in 5 cases. Conclusion Early phase surgical clipping for ruptured cerebral anterior circulating aneurysm can reduce the chance of reruputure of aneurysms and the mortality in preoperative phase with good outcomes. The early phase surgical clipping the aneurysms is considered the feasible opinion.
引用本文： 曾強(qiáng)軍,楊清,周明森,甘鄰元. 早期開顱手術(shù)夾閉顱內(nèi)前循環(huán)動(dòng)脈瘤. 華西醫(yī)學(xué), 2010, 25(7): 1276-1278. doi: 復(fù)制
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| 4. | 李進(jìn), 游潮, 賀民, 等. 大腦中動(dòng)脈動(dòng)脈瘤伴腦內(nèi)血腫的顯微手術(shù)治療(附15例分析)[J]. 中國微侵襲神經(jīng)外科雜志, 2008, 13(7): 304-306. |
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| 6. | 傅傳徑, 高覺民, 李善泉. 前循環(huán)破裂動(dòng)脈瘤的急診手術(shù)處理[J]. 中國腦血管病雜志, 2006, 3(10): 437-439. |
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- 1. 王忠誠. 神經(jīng)外科學(xué)[M]. 武漢: 湖北科學(xué)技術(shù)出版社, 1998: 599-601.
- 2. 顧宇翔, 毛穎, 宋冬雷, 等. 腦前循環(huán)動(dòng)脈瘤破裂早中期的顯微外科手術(shù)治療[J]. 中華外科雜志, 2006, 44(6): 412-415.
- 3. 楊立莊, 葉偉, 王社軍. 破裂腦動(dòng)脈瘤早期手術(shù)中破裂的探討[J]. 中華神經(jīng)外科雜志, 2001, 17(6): 387-388.
- 4. 李進(jìn), 游潮, 賀民, 等. 大腦中動(dòng)脈動(dòng)脈瘤伴腦內(nèi)血腫的顯微手術(shù)治療(附15例分析)[J]. 中國微侵襲神經(jīng)外科雜志, 2008, 13(7): 304-306.
- 5. Goddard AJ, Raju PP, Gholkar A. Does the method of treatment of acutely ruptured intracranial aneurysms influence the incidence and duration of cerebral vasospasm and clinical outcome[J]. J Neurol Neurosurg Psychiatry, 2004, 75(6): 868-872.
- 6. 傅傳徑, 高覺民, 李善泉. 前循環(huán)破裂動(dòng)脈瘤的急診手術(shù)處理[J]. 中國腦血管病雜志, 2006, 3(10): 437-439.
- 7. Molyneux A, Kerr R, Stratton I, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial[J]. Lancet, 2002, 360(9342): 1267-1274.