不同入路夹闭前循环动脉瘤的临床疗效分析

Analysis of clinical effect of different approaches for clipping anterior circulation aneurysms

目的对比经眶上外侧入路和经眶上锁孔入路夹闭前循环动脉瘤的治疗效果,以指导前循环动脉瘤手术入路的选择。方法回顾性分析2011年1月至2016年1月因自发性蛛网膜下腔出血确诊为前循环动脉瘤80例患者的临床资料,分为经眶上锁孔入路(A组)和眶上外侧入路(B组)。分析两组患者的手术时间、开颅时间、关颅时间、估计术中出血量、手术前后红细胞压积(HCT)改变、术后早期下床活动时间、术后住院时间、入院和出院时格拉斯哥昏迷评分(GCS评分)、出院时格拉斯哥预后评分(GOS评分)的差异并进行文献回顾。结果经眶上外侧入路的手术时间和开颅时间少于经眶上锁孔入路,差异有统计学意义(P<0.05)。两组关颅时间、估计术中出血量、手术前后HCT改变、术后早期下床活动时间、术后住院时间、入院和出院时GCS评分、出院时GOS评分差异无统计学意义(P>0.05)。结论经眶上外侧入路具有手术时间和关颅时间短,术中能提供更好的手术视野,术中牵拉较少和术后并发症少等优点,在行颅内前循环动脉瘤夹闭术时可作为眶上锁孔入路的替代方案。

Objective To compare the treatment effect of surgically clipping anterior circulation aneurysms by lateral supra- orbital approach and supraorbital keyhole approach for guiding the selection Of surgical approach for anterior circulation aneurysms. Methods The clinical data of 80 patients diagnosed as anterior circulation aneurysms due to spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed, including the operation time, craniotomy time, cranial closure time, estimated intraoperative blood loss, HCT change before and after surgery, early ambulation time, postoperative hospitalization days,GCS scores at admission and discharge, GOS scores at discharge were compared between the two groups and the literatures were reviewed. Results The operation time and craniotomy time of the lateral supraorhital approach were less than those of the su- praorbital keyhole approach,and the differences between the two groups were statistically significant （P〈0.05） ;the cranial closure time, estimated intraoperative blood loss, HCT change before and after surgery, early ambulation time, postoperative hospitalization days,GCS scores at admission and discharge and GOS scores at discharge had no statistical differences between the two groups （P〉0.05）. Conclusion The lateral supraorbital approach has the advantages of shorter operation time and craniotomy time,provi- ding a better surgical field during operation,less intraoperative traction and less postoperative complications,and can serve as an al- ternative scheme for the supraorbital keyhole approach in clipping anterior circulation aneurysms.