颅内动脉瘤3322例的临床特征和手术结果分析

Clinical characteristics and surgical outcomes of intracranial aneurysm：a retrospective study of 3322Climes

目的通过回顾性分析颅内动脉瘤病例对动脉瘤临床特征和外科手术愈后有初步理解。方法对1955年1月至2009年7月北京天坛医院收治的3322例颅内动脉瘤患者数据收集分析。按入院时间分为2组：A组为1992至2000年，B组由2001至2009年。评估临床特征变量：年龄、性别、人院Hunt-Hess分级、首发症状。通过比较两组手术并发症评估外科手术结果。术前两组采用Hunt-Hess分级系统评价。结果颅内动脉瘤高发年龄为38～54岁，其中出血（84．89％），占位效应（8．13％）和非出血性头痛发作（5．18％）是常见的3种症状，男女比例为0．875：1。两组间年龄分布和性别比率差异无统计学意义。A组与B年组相比，Ⅱ、Ⅲ、Ⅳ级患者比例下降，0级、Ⅰ级患者比例增加。主要外科手术并发症的发生率差异无统计学意义（P〉0．05）。结论动脉瘤主要临床症状为出血、占位及非出血性头疼。入院Hunt．Hess分级以为Ⅰ级和Ⅱ级为主。颅内动脉瘤主要位于颈内动脉、前交通动脉及大脑中动脉。女略多于男，但在前动脉、前交通、椎基底，男患者比女患者多。破裂动脉瘤女性多于男性。巨大动脉瘤的手术治疗除传统动脉瘤夹闭术，应结合病例具体情况考虑搭桥等手术方式。

Objective To preliminarily explore the clinical characteristics and surgical outcomes of intracranial aneurysm. Methods The data of 3322 cases of intracranial aneurysm from January 1955 to July 2009 were collected at our hospital for analysis. The clinical characteristics and surgical outcomes of patients with intracranial aneurysm were assessed. The surgical patients were divided into 2 groups by the date of admission：group A and group B. Such clinical characteristics as age, gender and Hunt-Hess grade at admission and first presentations were analyzed. The surgical outcomes were assessed by comparing the surgical complications between two groups. Results Intracranial aneurysms were commonly diagnosed between 38 and 54 years old. Hemorrhage （ 84. 89% ）, mass effect （ 8.13% ） and non-hemorrhagic headache （5.18%） were the three initial common presentations and the male-to-female ratio was 0. 875： 1. There was no significant statistical difference in age distribution and gender ratio between two groups. According to the Hunt-Hess grade, the percentage of grades Ⅱ, Ⅲ and Ⅳ was lower in group B while the percentage of grades 0 and Ⅰ higher than group A. No significant difference was found in the overall incidence of major post-operative complications between two groups （P 〉 0. 05）. Conclusion The major presentations of intracranial aneurysm are hemorrhage, mass effect and non-hemorrhagic headache. And the Hunt-Hess grades Ⅰ andⅡ patients account for a majority of aneurysms. Three most common locations of aneurysm are ICA-PCoA （internal carotid artery-posterior communicating artery）, ACoA （anterior communicating artery） and MCA （middle cerebral artery）. Giant aneurysm should be treated in the light of concrete conditions by choosing such a surgical approach as bypass.