开颅手术夹闭颅内单发动脉瘤285例回顾性分析

A retrospective study of surgical clipping for treatment of 285 cases of solitary intracranial aneurysm

目的评估开颅手术夹闭颅内单发动脉瘤的中长期疗效、并发症及影响预后的相关因素。方法收集285例行夹闭手术的颅内单发动脉瘤患者的治疗过程资料作回顾性分析。随访患者术后的症状、体征、改良Rankin量表评分、数字减影血管造影（digital subtraction angiography,DSA）复查情况、有无动脉瘤再出血等来评估开颅手术夹闭颅内动脉瘤的效果,并进行多因素Logistic回归分析。结果所有285例患者出院时,预后良好率（改良Rankin量表评分0~2分）为83.5%,预后不良率为16.5%,死亡率为4.2%。196例中长期随访时（平均57.5个月）,预后良好率为84.2%,预后不良率为15.8%,死亡率为3.6%。1例发生动脉瘤再出血,再出血率为0.5%。104例患者术后复查各类血管造影影像学检查,有1例患者动脉瘤复发,1例疑似复发,余未见异常。多因素回归分析提示Hunt-Hess分级、术中动脉瘤破裂和迟发性缺血性障碍（delayed ischemic deficits,DID）是影响患者预后的重要因素。结论开颅手术夹闭作为一种预防颅内单发动脉瘤再次破裂出血的有效方法更适合于临床状态好（Hunt-Hess分级低）的患者。预防动脉瘤术中破裂出血,避免DID及术中应用Doppler血管超声能够提高手术的长期疗效。

Objective To assess the mid-or long-term effect and complications of surgical clipping for solitary intracranial aneurysm and to analyze the factors affecting prognosis.Methods Data of two hundred and eighty-five patients with solitary intracranial aneurysm treated by surgical clipping procedure were collected into this retrospective research.The patients＇ symptoms,signs,modified Rankin scale（mRs）,DSA exam and episodes of rebleeding were followed up to assess the effect of surgical clipping.Multi variable Logistic regression was used to analyze the related factors affecting prognosis.Results All of the 285 aneurysms had been surgically clipped,83.5% of them had good outcomes（mRs 0-2） when being discharged from hospital,16.5% of them had unfavourable prognosis and 4.2% of them died.84.2% of 196 patients had good outcomes at mid-or long-term follow-up（mean 57.5 months）,15.8% of them had bad outcomes and 3.6% of them died.Among 176 patients,1 patient suffered rebleeding of aneurysm.The rebleeding rate was 0.5% of 104 patients who took various cerebrovascular angiogram for follow-up,1 was confirmed as recurrence,1 was doubted recurrence of aneurysm,and nothing abnormal was discovered in the other patients.Hunt-Hess scale,intra-operative rupture and delayed ischemic deficits（DID） were the related factors that affecting prognosis.Conclusions Surgical clipping was an effective method to prevent intracranial aneurysm from rebleeding.It was more suitable for the patients in better clinical state（lower Hunt-Hess scale）.The patients＇ long-term prognosis could be improved by preventing intra-operative rupture,avoiding DID,and application of intra-operative vascular Doppler.