后交通动脉瘤性动眼神经麻痹术后恢复情况的临床观察

Postoperative recovery of aneurysm of posterior communicating artery-induced oculomotor palsy: clinical observation of 52 cases

目的探讨后交通动脉瘤性动眼神经麻痹术后恢复情况,并分析其影响因素.方法回顾分析我院4年来收治的98例后交通动脉瘤患者,其中52例合并有单侧动眼神经麻痹表现,所有患者均经过全脑数字减影血管造影检查,明确后交通动脉瘤诊断后行开颅手术治疗.术后随访分两组观察动眼神经麻痹恢复情况.A组:单纯动脉瘤蒂夹闭术;B组: 动脉瘤蒂夹闭术后行动眼神经减压术.结果 A组20例,其中病程在14 d内手术者10例,术后10～40 d内动眼神经麻痹完全恢复;14～30 d内手术者8例,7例术后30～90 d动眼神经麻痹完全恢复,1例不完全恢复;30 d后手术者2例,术后半年1例动眼神经麻痹完全恢复,1例不完全恢复.B组32例,其中病程在14 d内手术者15例,术后10～40 d内动眼神经麻痹完全恢复;14～30 d内手术者14例,12例术后30～90 d动眼神经麻痹完全恢复,2例不完全恢复;30 d后手术者3例,术后半年2例动眼神经麻痹完全恢复,1例不完全恢复.结论后交通动脉瘤性单侧动眼神经麻痹患者早期明确诊断及尽早手术治疗,对术后动眼神经麻痹恢复极为重要,但术中是否行切除或穿刺动脉瘤等动眼神经减压术,同术后动眼神经麻痹恢复时间无明显差别.

Objective To explore the prognosis of aneurysm of posterior communicating artery-induced oculomotor palsy after surgery. Methods Fifty-two patients with aneurysm of posterior communicating artery-induced oculomotor palsy, 12 males and 40 females, aged 57, diagnosed by CT, MRI, and digital subtraction angiography, were divided into 2 groups: group A ( n =20, receiving simple clipping of the aneurysmal neck) and group B ( n =32, undergoing clipping of the aneurysmal neck followed by nerve decompression such as resection or puncture of the aneurysmal sac), and were followed up for 12 months (2-48 months). Results In the group A 10 patients were operated on within 14 days after the onset of oculomotor palsy showed complete recovery of the oculomotor nerve function within 40 days after operation; 8 patients were operated on within 14-30 days after the onset of oculomotor palsy showed complete recovery within 30-90 days after operation in 7 patients and incomplete recovery in 1 patient; and 2 patients were operated on 30 days after the onset of oculomotor palsy showed complete recovery within 6 months after operation in 1 patient and incomplete recovery in the other patient. In the group B 15 patients were operated on within 14 days after the onset of oculomotor palsy all showed complete recovery within 40 days after operation; 14 patients were operated on within 14-30 days after the onset of oculomotor palsy showed complete recovery within 30-90 days after operation in 12 patients and incomplete recovery in 2 patients; and 3 patients were operated on 30 days after the onset of oculomotor palsy showed complete recovery within 6 months after operation in 2 patients and incomplete recovery in the other one patient. There was no significant difference in the recovery rate between these 2 groups. Recovery of the oculomotor nerve function was remarkably correlated with the time of operation after the onset. Conclusion Early diagnosis and treatment help recover the oculomotor nerve function. The recovery of the oculomotor nerve function is not related to the operation protocols.