动脉瘤性蛛网膜下隙出血后并发急性脑积水早期动脉瘤夹闭术联合终板造瘘术的疗效评价

Efficacy of early aneurysm clipping combined with lamina terminalis fenestration in treating acute hydrocephalus after aneurismal subarachnoid hemorrhage

目的 评价动脉瘤性蛛网膜下隙出血（aSAH）后并发急性脑积水早期动脉瘤夹闭术联合终板造瘘术的临床疗效.方法 选择2013年2月至2016年8月收治的112例aSAH后并发急性脑积水患者,早期均给予开颅动脉瘤夹闭术,依据治疗方式分成对照组（单纯动脉瘤夹闭术,48例）及观察组（单纯动脉瘤夹闭术联合终板造瘘术,64例）.对比两组患者急性脑积水好转率、术后行脑室-腹腔分流术比例,同时再对比责任动脉瘤部位对上述两个指标影响情况.结果 观察组急性脑积水好转率57.8%（37/64）,明显高于对照组的31.2%（15/48）,差异有统计学意义（P〈0.05）;而观察组术后行脑室-腹腔分流术者占25.0%（16/64）,与对照组的31.3%（15/48）比较,差异无统计学意义（P〉0.05）.观察组中后循环动脉瘤患者的急性脑积水好转率（84.0%,21/25）、术后行脑室-腹腔分流术比例（12.0%,3/25）,与对照组（分别为4/16、6/16）比较,差异均有统计学意义（P〈0.01）.结论 aSAH后并发急性脑积水给予早期动脉瘤夹闭术联合终板造瘘术疗效佳,而针对后循环动脉瘤患者其疗效更佳.

Objective To explore the efficacy of early aneurysm clipping combined with lamina terminalis fenestration in the treatment of acute hydrocephalus after aneurismal subarachnoid hemorrhage. Methods One hundred and twelve patients of acute hydrocephalus after aneurismal subarachnoid hemorrhage who were treated by early aneurysm clipping were retrospectively analyzed from February 2013 to August 2016. These cases were divided into 2 groups： control group （aneurysm clipping alone, 48 cases） and observation group （clipping with lamina terminalis fenestration group, 64 cases）.The improving rate of acute hydrocephalus and incidence rate of shunt-dependent hydrocephalus after surgical treatment were compared between 2 groups. Results The improving rate of acute hydrocephalus in observation group was significantly higher than that in control group：57.8%（37/64）vs. 31.2% （15/48）, and there was statistical difference （P〈0.05）. There was no statistical difference in incidence rate of shunt-dependent hydrocephalus after surgical treatment between observation group and control group：25.0%（16/64）vs.31.2%（15/48）,P〈0.05.The improving rate of acute hydrocephalus and incidence rate of shunt-dependent hydrocephalus after surgical treatment in patients with posterior circulation aneurysm of observation group were showed significant differences： 84.0% （21/25） vs. 4/16 and 12.0%（3/25）vs.6/16,P〈0.01.Conclusions The efficacy of early lamina terminalis fenestration in the treatment of acute hydrocephalus after aneurismal subarachnoid hemorrhage is effective in posterior circulation aneurysm clipping.