脑前循环动脉瘤破裂早中期的显微外科手术治疗

Early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm

目的评价脑前循环动脉瘤破裂早、中期显微外科手术治疗的疗效。方法2001年1月至2004年8月对75例脑前循环动脉瘤破裂的急性自发性蛛网膜下腔出血患者应用显微神经外科技术在早期（3d之内）、中期（3～10d）进行手术治疗，以格拉斯哥术后评分量表（GOS）对患者神经功能评分。结果81个动脉瘤，显微手术夹闭77个，包裹4个。恢复良好53例；中度病残，但生活自理9例；重度病残，生活不能自理7例；植物生存3例；死亡3例。HuntⅠ～Ⅲ级的S预后评分明显优于Ⅳ、Ⅴ级患者，时间早期（3d之内）与中期（3～10d）施行手术后的GOS评分无明显差异。结论早、中期显微手术是治疗脑前循环动脉瘤破裂的理想手段。

Objective To evaluate clinical strategy and effect of early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm. Methods Seventy-five patients presenting with anterior circulating aneurysmal subarachoid hemorrhage （SAH） underwent early-mid-phase （within 3 days or 3-10 days） microsurgical clipping at Huashan Hospital between January 2001 and August 2004. Glasgow outcome scale （COS）was conducted to evaluate patients＇ outcomes. Results Of 81 intracranial aneurysms, 77 lesions were clipped successfully, and 4 were wrapped. Good outcome was achieved in 53 cases, mild disability in 9 cases, severe disability in 7 cases, persistent vegetative state in 3 cases, and 3 patients （4%） died after surgery. The difference of GOS was statistically significant between patients in Hunt and Hess Grade Ⅰ -Ⅲ and Grade Ⅳ-Ⅴ. However, there was no significant difference between early surgery and metaphase surgery. Conclusions Early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm is considered the feasible opinion.