手术夹闭与介入栓塞治疗对后交通动脉瘤动眼神经麻痹恢复的疗效比较

目的比较手术夹闭与介入栓塞治疗后交通动脉瘤伴动眼神经麻痹的临床疗效。方法回顾性分析2005年10月至2009年10月后交通动脉瘤伴动眼神经麻痹患者68例的临床资料，其中手术夹闭治疗43例（夹闭组），介入栓塞治疗25例（栓塞组）。结果治疗后两组患者眼裂均增大，瞳孔缩小，与治疗前比较差异有统计学意义（P〈O．05），但夹闭组改善幅度更大，两组比较差异有统计学意义（P〈O．05）。随访6个月，夹闭组患者动眼神经麻痹完全恢复34例（79．07％）、部分恢复8例（18．60％）、未恢复1例（2．33％）；栓塞组患者完全恢复13例（52．00％）、部分恢复10例（40．00％）、未恢复2例（8．00％），差异有统计学意义（P〈O．05）。夹闭组完全恢复时间（30．90±5．47）d，短于栓塞组的（47．83±6．62）d，差异有统计学意义（P〈O．05）。结论手术夹闭治疗后交通动脉瘤伴动眼神经麻痹的临床效果优于介入栓塞治疗，值得临床推广应用。

Objective To compare the clinical effieacies of clipping operation and interventional embolotherapy in treatment of posterior communicating aneurysm accompanied by oculomotor palsy. Methods The clinical data of 68 patients with internal carotid artery - posterior communicating aneurysm accompanied by oculomotor palsy treated by our department between October 2005 and October 2009 were retrospectively analyzed. Among them, 43 patients were treated by clipping operation （ clipping operation group ） , and 25 patients treated by interventional embolotherapy （ intervemional embolotherapy group ） . Results After the treatments, the palpebral fis^ure~ of the affected eyes were enlarged and the pupils of the affected eyes were contracted in the patients of both groups, and the differences were statistically significant when compared with those before the treatments （ P〈0.05 ） , but the clipping operation group had greater improving extents （ P〈0.05 ） . All the patients were followed up for 6 months, the oculomotor palsy was completely recovered in 34 patients （ 79.07% ） , partially recovered in 8 patients （ 18.60% ） , and not recovered in 1 patient （ 2.33% ） of the clipping operation group, while it was completely recovered in 13 patients （ 52.00% ） , partially recovered in 10 patients （ 40.00% ） , and not changed in 2 patient （ g.00% ） of the interventional embolotherapy group, and the differences were statistically significant （ V〈0.05 ） . The complete recovery time of the clipping operation group was （ 30.90 ± 5.47 ） d, shorter than that of the interventional embolotherapy group [ （ 47.83 ± 6.62 ） d ] , and the difference was statistically significant （ P〈0.05 ） . Conclusion Clipping operation in treatment of posterior communicating aneurysm accompanied by oculomotor palsy had better clinical efficacies and shorter recovery time from oculomotor palsy than interventional embolotherapy, and consequently is worthy of clinical application.