前交通动脉瘤的临床分型和显微手术治疗策略

The clinical classification and microsurgical strategies of anterior communicating artery aneurysms

目的通过研究前交通动脉瘤的临床分型与手术难度和预后的关系,探讨前交通动脉瘤的显微手术治疗策略。方法将68例前交通动脉瘤分为视交叉型和纵裂型。对于视交叉型,在抬起额叶前先预先阻断载瘤动脉,然后分离动脉瘤将其夹闭;对于纵裂型,将载瘤动脉临时阻断后,采用瘤体翻转技术将瘤颈显露清楚后将其夹闭。结果瘤颈成功夹闭68例。在术中共有54例(79%)发生了动脉瘤破裂出血。视交叉型组的恢复良好率为95%(22/23),纵裂型的恢复良好率为89%(40/48)。结论视交叉型前交通动脉瘤容易早期破裂,但是分离和夹闭比较容易;纵裂型前交通动脉瘤不易早期破裂,但分离和夹闭比较困难。

Objective To explore the effective operative strategies in the microsurgical clipping of anterior communicating artery （ACoA） aneurysms by studying the relationship between the clinical classification of ACoA aneurysm and the surgical difficulty as well as the outcome of patients. Methods A total of 68 cases with ACoA aneurysms were divided into optic chiasm group （OCG） and longitudinal fissure group （LFG）. As for the aneurysms of OCG, the parent arteries were blocked temporarilly before elevating frontal lobe and then the necks of aneurysms were clipped after they were separated from adjacent perforating artery. As for the aneurysms of LFG, upturning and electric-coagulating the bodies of aneurysms were performed after the parent arteries were blocked temporarilly, and then the necks of aneurysm were revealed and clipped. Results Clipping of aneurysms was successfully achieved in all the cases. During operation the rupture of aneurysms occurred in 54 of 68 cases （79%）. The rate of returning to normal health status in OCG group and in LFG group was 95% and 89% respectively, where was significant statistical difference （P 〈 0. 01 ）. Conclusion The ACoA aneurysms of OCG are easy to be dissected and clipped although they are prone to early rupture, while the case for ACoA aneurysms of LFG is opposite to the former.