3D—CTA模拟手术在前交通动脉瘤手术入路选择中的应用

Application of 3D - CTA for selection of a surgical approach to anterior communicating artery aneurysms

目的探讨三维CT血管造影（3D—CTA）在前交通动脉瘤手术入路选择中的指导意义。方法回顾性分析均采用Yasargil入路手术治疗的53例前交通动脉瘤破裂患者的临床资料，其特点均为A1优势侧入路动脉瘤显露不佳，而非优势侧显露良好。将这些患者随机分为观察组（采用A1非优势侧入路）和对照组（采用A1优势侧入路），对比分析两组从硬膜打开到动脉瘤处理完成时间、手术失血量以及术中动脉瘤破裂数的差异。结果观察组28例，对照组25例，2组从硬膜打开到动脉瘤处理完成时间分别为（31．00±7．43）min和（61．40±11．05）min（P〈0．05），手术失血量分别为（81．254-18．59）ml和（86．80±25．33）m1（P〉0．05），术中动脉瘤破裂数分别为1个和3个（P〉0．05）。结论对于A1段优势的前交通动脉瘤可在3D—CTA辅助下经非优势侧入路行动脉瘤夹闭，可显著缩短从硬膜打开到动脉瘤处理完成时间，并取得同A1优势侧入路侧相同的夹闭效果。

Objective To evaluate the application of three - dimensional computed tomography angiography （3D - CTA） for selection of a surgical approach to anterior communicating artery aneurysms. Methods A retrospective analysis was performed in 53 patients with ruptured anterior communicating artery（AcomA） aneurysms who were treated surgically through the Yasargil＇s approach. These AcomA aneurysms were characterized in their poor exposure at the A1 dominant side, but good exposure at the non - dominant side. These patients were randomly divided into an observation group （via the A1 non- dominant side approach） and a control group （via A1 dominant side approach）. Then, both groups were compared for the time from dural opening to aneurysm clipping, blood loss during surgery and the number of intraop- erative ruptured aneurysms. Results There were 28 patients in the observation group and 25 in the control group. The time from dural opening to aneurysm clipping was （31.00 ±7.43 ） min for the observation group and （ 61.40 ±11.05 ） min for the control （P 〈 0.05）. The blood loss was （81.25 ±18.59） ml for the observation group and （86.80 ±25.33） ml for the control （P 〉 0.05）. The number of intraoperative ruptured aneurysms was 1 for the observation group and 3 for the control （P 〈 0.05）. Conclusions Using 3 D - CTA assisted non - dominant side approach, AcomA aneurysms can be clipped at the A1 dominant segment, which can significantly shorten the time from dural, opening to aneu- rysm treatment, with the same clipping effect through the A1 dominant side.