显微手术治疗破裂前交通动脉瘤的临床疗效观察

Observation on Clinical Efficacy of Microsurgery for the Treatment of Ruptured Anterior Com- municating Artery Aneurysm

【目的】探讨显微手术治疗破裂前交通动脉瘤的临床疗效。【方法】回顾性分析本院82例破裂前交通动脉瘤患者的一般资料、影像学检查、手术时机、手术方法、术后处理及治疗效果。【结果182例动脉瘤均成功夹闭；术后生存80例（97．6％），死亡2例（2．4％）。手术并发脑血管痉挛15例（18．3％），脑梗死8例（9．8％），脑积水6例（7．3％）。出院后随访6～36个月，未见动脉瘤再破裂出血。出院时GOS预后评分结果显示，V级65例；Ⅳ级7例，Ⅲ级5例，Ⅱ级3例，I级2例。分析手术时机与手术疗效的关系显示，Hunt—Hess I～Ⅲ级组、Ⅳ～V级组患者蛛网膜下腔出血（SAH）后早、中、晚期手术预后相比较差异无显著性（P〉0．05）。【结论】破裂前交通动脉瘤一旦确诊，应积极创造条件、争取尽早手术，术中应重视动脉瘤显露和避免再破裂出血，术后积极防治脑血管痉挛、脑梗死和脑积水，以顺利度过手术期，提高治愈率、降低病死率和致残率。

[Objectivel To explore the clinical efficacy of microsurgery for the treatment of ruptured anteri- or communicating artery aneurysm. [Methods] General information, imaging examination results, operation opportunity, operation method, postoperative management and efficacy of 82 patients with ruptured anterior communicating artery aneurysm were analyzed retrospectively. [Results] All 82 patients were successfully clipped. After microsurgery treatment, 80 patients（97.6%） survived and 2 patients（18.3 % ） died. Fifteen pa- tients（18.3 % ） were complicated with cerebral vasospasm, and 8 patients（9.8% ） were complicated with cere- bral infarction, and 6 patients（7.3 %） were complicated with hydrocephalus. After discharge, all patients were followed up for 6 -36 months. No aneurysm rupture rebleeding occurred. At discharge, Glasgow outcome scale（GOS） showed that 65 patients were grade V , and 7 patients were grade IV, and 5 patients were grade III , and 3 patients were grade II and 2 patients were grade I . The analysis on the relationship between opera- tion opportunity and efficacy showed that there was no significant difference in the prognosis in early, middle and late stage among patients with subarachnoid hemorrhage in Hunt-Hess I -III and Hunt-Hess IV- V （ P 〉0.05）. [Conclusionl Once anterior communicating artery aneurysm before rupture is diagnosed, the opera- tion should be performed as early as possible. The exposure of aneurysm should be paid attention and rupture rebleeding should be avoided during the operation. After the Operation, cerebral vasospasm, cerebral infarction and hydrocephalus should be actively prevented and treated so as to pass through the operation period smoothly, improve the curative rate and reduce the mortality and disability.