微创手术治疗后交通动脉瘤28例分析

Analysis of 28 cases of patients with posterior communicating artery aneurysms treated by minimally invasive surgery

目的：探讨显微镜下微创手术治疗后交通动脉瘤的手术时机、方法以及效果。方法回顾性分析2009年1月~2010年1月于四川大学华西医院行显微镜下翼点入路后交通动脉瘤瘤颈夹闭术28例患者，术中荧光造影。术后6个月和1年分别进行随访，观察分析患者的格拉斯哥预后分级（GOS）。结果随访6～12个月，观察其GOS评分；28例患者中，死亡（GOS分级I级）1例（3.57%）、植物生存（GOS分级Ⅱ级）1例（3.57%）、重度残疾（GOS分级Ⅲ级）2例（7.14%）、中度残疾（GOS分级Ⅳ级）5例（17.86%）、恢复良好（GOS分级Ⅴ级）19例（67.86%）。结论对于后交通动脉瘤Hunt-Hess分级I～Ⅲ级的患者应尽早手术，Ⅳ～Ⅴ级患者病情稳定后再手术；显微镜下翼点入路后交通动脉瘤瘤颈夹闭术，术中荧光造影，夹闭瘤颈可靠，是一种有效的方法。

Objective To explore the operative time, methods and effect of minimally invasive surgery in the treatment of posterior communicating artery aneurysms. Methods 28 cases of patients with posterior communicating artery a-neurysms treated by microsurgical clipping surgery from January 2009 to January 2010 in West China Hospital of Sichuan University were analyzed retrospectively, fluorescence imaging was taken during the operation, all patients were followed-up 6 months and 1 year after operation, the GOS scores of patients were observed and analyzed. Results Followed-up for half year to one year, the GOS was observed, which showed that：among 28 cases of patients, there was 1 case （3.57%） of death （GOS gradeⅠ）, 1 case （3.57%） of plant survival （GOS gradeII）, 2 cases （7.14%）of severe dis-abilities （GOS grade Ⅲ）, 5 cases （17.86%） of incomplete （GOS grade Ⅳ）,19 cases （67.86%） of good （GOS grade Ⅴ）. Conclusion The operation should be done as early as possible in the patients of posterior communicating artery a-neurysms with GradeⅠ-Ⅲ of Hunt-Hess;patients with GradeⅣ-Ⅴ of Hunt-Hess should be treated by conservative therapy first; microsurgical clipping surgery treating posterior communicating artery aneurysms is a good procedure be-cause of the clear exposure, reliable clipping.