血管介入栓塞术与开颅夹闭术治疗老年后交通动脉瘤并动眼神经麻痹的效果及预后对比研究

Prognostic Analysis of Endovascular Embolization and Surgical Clipping for Posterior Communicating Artery Aneurysm Caused Oculomotor Palsy in Elder Patients

目的比较观察血管介入栓塞术和开颅夹闭术治疗老年后交通动脉瘤(posterior communicating artery aneurysm,Pcom AA)并动眼神经麻痹(oculomotornerve palsy,0MNP)的效果及预后。方法回顾性分析2008年1月—2013年6月在我院接受治疗的322例Pcom AA并0MNP临床资料,按手术方式分为栓塞组(行血管介入栓塞治疗)162例和夹闭组(行开颅夹闭术治疗)160例,比较两组手术相关指标、0MNP恢复效果及术后并发症情况。结果栓塞组手术时间、术后恢复自主呼吸时间及术中出血量均显著优于夹闭组,差异均有统计学意义(P<0.01)。夹闭组OMNP完全恢复率高于栓塞组(P<0.05),但两组OMNP总恢复率比较差异无统计学意义(P>0.05)。栓塞组术后脑梗死、脑血管痉挛、脑水肿及脱水发生率显著低于夹闭组(P<0.05或P<0.01)。结论血管介入栓塞术和开颅夹闭术治疗老年Pcom AA并0MNP有着各自的优势与缺点,临床医师需根据患者综合情况选择合适的手术治疗方式。

Objective To study the prognostic analysis of endovascular embolization and surgical clipping for posterior communicating artery aneurysm caused oculomotor palsy in elder patients.Methods 322 cases of elderly patients in our hospital from the January 2008-2013 year in June were analyzed retrospectively, whose symptoms were oculomotor paralysis caused by Posterior communicating artery aneurysm.According to the different ways of operation, these patients were divided into embolization group and occlusion group.The embolization group were 162 cases, 160 cases were clipped.Related surgical factors, recover of OP and postoperative complications were compared.Results The embolization group operation time（2.11＆#177;0.28）h, recovery time of spontaneous breath in time（0.58＆#177;0.12）h were significantly shorter than the clipping group, and the amount of bleeding（9.35＆#177;3.61）ml was less than the clipping group, the differences between the two groups were statistically significant （P〈0.01）.The recovery effect of clipping group was better than that of embolization group, the difference was statistically significant （P〈0.05）, but there was no significant differences in recovery rate between the two groups （P〉0.05）.The postoperative complications such as cerebral infarction, vasospasm, cerebral edema, dehydration and other complications were significantly less than that of the clipping group, and the difference was statistically significant （P〈0.05 or P〈0.01）.Conclusion Endovascular embolization and microsurgical clipping have their advantages and disadvantages for aneurysm oculomotor paralysis in elderly patients, and clinicians should be based on the comprehensive conditions of patients suggest appropriate surgical modality for patients.