经眶上外侧入路或翼点入路治疗破裂前交通动脉瘤的临床对比研究

A Comparative Study of Transorbital Approach or Pterional Approach in the Treatment of Preruptured Communicating Artery Aneurysms

目的通过分析眶上外侧入路或翼点入路显微手术夹闭破裂前交通动脉瘤患者的临床资料,比较两组的有效性及安全性。方法收集2014年11月~2017年5月我科118例破裂前交通动脉瘤患者的临床资料,根据手术方式分为两组,其中采用眶上外侧入路61例,采用翼点入路57例,比较两组患者术前基线资料、术中情况、术后并发症及出院时GOS评分。结果两组患者术后1周内头颅CTA检查证实动脉瘤均被完全夹闭。眶上外侧入路手术切口长度(11.2±1.1)cm、骨瓣大小(2.8±0.2)cm^2、手术时间(184±38)min、手术出血量(170±147)ml低于翼点入路手术切口长度(16.4±2.1)cm、骨瓣大小(5.1±0.4)cm^2、手术时间(258±50)min、手术出血量(221±101)ml;眶上外侧入路颅内感染率9.80%。及头皮愈合不良率0低于眶上外侧入路颅内感染率24.50%及头皮愈合不良率7.00%,对比均存在统计学意义(P<0.05)。眶上外侧入路动脉瘤破裂率6.50%、术后慢性脑积水发生率4.90%及出院时预后良好率91.80%与翼点入路术中动脉瘤破裂率3.50%、术后慢性脑积水发生率5.20%及出院时预后良好率85.90%比较无差异,不存在统计学意义(P>0.05)。结论经眶上外侧入路与翼点入路均能安全、有效夹闭前交通动脉瘤,但眶上外侧入路具有高效、创伤小、术后并发症少等优势。

Objective To analyze the clinical data of patients with communicating artery aneurysm ruptured by microsurgical supraorbital lateral approach or pterional approach to compare the effectiveness and safety of the two groups.Methods The clinical data of 118 patients with ruptured traffic artery aneurysm from November 2014 to May 2017 were collected and divided into two groups according to the operation mode.Among them,61 cases were treated by supraorbital lateral approach and 57 cases were treated by pterional approach preoperative baseline data,intraoperative status,postoperative complications and GOS scores at discharge were compared between the two groups.Results CTA examination within 1 week after operation in both groups confirmed that aneurysms were completely occluded.The length of the surgical incision(11.2±1.1)cm,the size of the bone flap(2.8±0.2)cm2,the operation time(184±38)min and the surgical bleeding volume(170±147)ml were lower than those of the pterional approach The length of incision(16.4±2.1)cm,the size of the flap(5.1±0.4)cm2,the operation time(258±50)min and the amount of bleeding during operation(221±101)ml,the rate of intracranial infection in supraorbital lateral approach was(9.80%),and the rate of poor scalp healing was 0 in 14 cases(24.50%)and(7.00%)were lower than those in supraorbital approach.There was statistical significance(P<0.05).(6.50%)had ruptured aneurysm in superior lateral supraorbitalis,(4.90%)had postoperative chronic hydrocephalus and(91.80%)had good prognosis at discharge.There were no significant differences in tumor rupture rate in(3.50%),postoperative chronic hydrocephalus incidence in 3 cases(5.20%)and discharge at discharge in(85.90%),with no statistical significance(P>0.05).Conclusion The supraorbital lateral approach and the pterional approach can safely and effectively occlude the anterior communicating artery aneurysm.However,the supraorbital approach has the advantages of high efficiency,less trauma and less postoperative complications.