急诊开颅夹闭联合脑室穿刺治疗中高级别颅内破裂动脉瘤的疗效分析

Analysis of emergent aneurysm clipping with ventricular puncture for medium and high level aneurismal subarachnoid hemorrhage

目的探讨急诊开颅夹闭中高级别破裂动脉瘤手术方法,以提高手术治疗效果。方法回顾性分析70例中高级别动脉瘤性蛛网膜下腔出血急诊开颅动脉瘤夹闭术,脑室穿刺组46例,开颅后先行额叶侧脑室穿刺释放脑脊液,之后行传统动脉瘤夹闭术。对照组24例,为传统动脉瘤夹闭术。结果脑室穿刺组患者术后恢复明显好于对照组患者。对照组术后短期及长期并发症概率均高于脑室穿刺组。结论应用术中脑室穿刺技术可明显降低颅压,充分暴露手术视野,减轻脑叶牵拉,减少脑重要功能区的损伤,提高术后患者生存质量。

Objective To evaluate the techniques for emergency aneurysm clipping with ventricular puncture of the middle and high level aneurismal subarachnoid hemorrhage （aSAH） , and improve surgical effects of operation. Methods The clinical data of 70 patients with medium and high level aSAH underwent emergency aneurysm clipping with ventricular puncture were analyzed retrospectively. Of 70 patients ,46 in ventricular puncture group were underwent ventricular puncture on the lobus frontalis before tradition aneurysm clipping. 24 in control group were purely operated by the tradition aneurysm clipping. Results The therapeutic effect of ventricular puncture group was much better than the control group, the short and long term postoperative complication probability of the control group was higher than the ventricular puncture group. Conclusion The technique of ventricular puncture can reduce the intracranial pressure obviously, expose the operative field entirely, lessen the traction injury of the brain lobe, decrease the damage to important functional area of the brain and improve survival quality.