不同显微外科手术入路方式及时机对后循环动脉瘤疗效的影响

The Influence of Different Surgical Approaches and Operation Timing of Microsurgery on the Curative Effects of Posterior Circulation Aneurysms

目的:探讨显微外科手术入路方式及时机对后循环动脉瘤疗效的影响。方法:回顾性分析2011年5月至2017年11月在我院接受显微外科手术治疗的40例后循环动脉瘤患者的临床资料,根据发病至手术时间分为早期组(3d之内)、中期组(4～14d)、延期组(超过14d),分别为15例、13例、12例。另选取同时期在我院接受显微外科手术治疗后循环动脉瘤患者40例,根据手术入路方式分为扩大翼点入路(11例)、翼点入路(9例)、颞下入路(13例)、乙状窦后入路(7例),对所有患者均进行为期6个月的随访。比较不同入路方式及手术时机临床疗效及预后情况。结果:早期组的临床疗效明显优于中期组、延期组,差异具有统计学意义(P<0.05);早期组的预后优良率和中期组、延期组相比,差异无统计学意义(P>0.05);翼点入路手术总有效率、预后优良率均明显低于扩大翼点、颞下、乙状窦后入路,差异具有统计学意义(P<0.05);扩大翼点、颞下、乙状窦后入路临床疗效、预后情况相比,差异无统计学意义(P>0.05)。结论:不同的显微外科手术入路方式及时机均会对后循环动脉瘤疗效产生一定的影响,选择合适的手术时机及入路方式,可显著提高疗效,预后良好,提高患者的生存质量。

Objective: To investigate the influence of surgical approach and operation timing of microsurgery on the curative effects of posterior circulation aneurysms. Methods: Clinical data of 40 cases of patients with posterior circulation aneurysms admitted into our hospital from May 2011 to November 2017 who received microsurgery were retrospectively analyzed. According to the duration of onset to operation, they were divided into three groups, that is, early stage group (within 3d), middle stage group (4 to 14d), and delayed group (over 14d), 15 cases, 13 cases and 12 cases respectively.In addition, 40 cases of patients with posterior circulation aneurysms treated by microsurgical treatment in our hospital were selected according to surgical approaches. All the patients were divided into extensive pterional approach (11 cases), pterional approach (9 cases), subtemporal approach (13 cases) and retrosigmoid approach (7 cases). And all patients were arranged with 6 months of follow-up. The clinical efficacy and prognosis of different surgical approaches and timing were compared. Results: The clinical efficacy of early stage group was significantly better than middle stage group and delayed group (P<0.05);There was no statistical difference in the rate of good prognosis compared among the three groups (P>0.05);The total effective rate and the rate of good prognosis of pterional approach surgery were significantly lower than extensive pterional approach, subtemporal approach and retrosigmoid approach (P<0.05);There was no statistical difference in the clinical efficacy and prognosis among extensive pterional approach, subtemporal approach and retrosigmoid approach (P>0.05). Conclusion: Different microsurgical approaches and timing will have a certain impact on the curative effect of posterior circulation aneurysms. Choosing appropriate surgical timing and approaches can significantly improve the curative effect, good prognosis and improve the quality of life of patients.