前交通动脉瘤夹闭术中临时阻断策略对术后早期脑缺血的影响

Effects of temporary arteries occlusion on early stage ischemia after microsurgical obliteration of anterior communicating artery aneurysms

目的:提出合理的前交通动脉瘤夹闭术中载瘤动脉临时阻断策略以降低术后早期医源性脑缺血的发生率。方法:回顾性研究117例开颅夹闭术的前交通动脉瘤,其中107例(91.5%)为破裂动脉瘤,临时阻断94例(80.3%)且平均阻断时间为(16.6±5.9)min。结果:临时阻断组中13例(14.1%)发生术后早期脑缺血,无临时阻断组无术后早期脑缺血发生。单侧A1优势供血的破裂前交通动脉瘤,双侧临时阻断较优势侧阻断更易发生术后早期脑缺血(P<0.05);双侧A1均势供血的破裂前交通动脉瘤,双侧阻断和术侧阻断术后早期脑缺血几率无显著差异(P>0.05),但前者的阻断时程显著长于后者(P<0.05);未破裂前交通动脉瘤,均无术后早期脑缺血发生。结论:术中临时阻断与术后早期医源性脑缺血密切相关,建议在前交通动脉瘤夹闭术中不首选临时阻断或仅对优势侧或术侧A1进行临时阻断。

Objective To explore the optimal temporary artery occlusion during anterior communicating artery aneurysms clipping to reduce the occurrence of postoperative early iatrogenic cerebral ischemia. Methods Totally 117 cases were studied retrospectively, of which 107 （91.5%） were with ruptured aneurysm. Temporary artery occlusion was applied in 94 （80.3%） with （16.6 ± 5.9）min occlusion duration. Results Of cases with temporary artery occlusion, early stage ischemia occurred in 13 （14.1%）, and cases without occlusion spared from early stage ischemia. For ruptured cases with dominant A1, bilateral occlusion was more likely to cause ischemia than predominant A1 occlusion （P 〈 0.05）. For ruptured cases with two equal A1, although there was no significance （P 〉 0.05）, occlusion duration was remarkably prolonged for bilateral occlusion cases （P 〈 0.05）. No occurrence of early stage ischemia was found in all unruptured cases. Conclusion Early stage iatrogenic ischemia is closely correlated with temporary artery occlusion, consequently, temporary artery occlusion should not be the first choice, and if necessary, ipsilateral occlusion is recommended.