眶上外侧入路与翼点入路手术治疗急性期颅内前循环破裂动脉瘤的临床对比分析

Clinical comparative analysis of supraorbital lateral approach and pterional approach for acute intracranial anterior circulation ruptured aneurysms

目的研究急性期颅内前循环破裂动脉瘤患者采用眶上外侧入路与翼点入路手术治疗的效果。方法选择2017年11月至2019年6月于廊坊爱德堡医院神经外科就诊的急性期颅内前循环破裂动脉瘤患者84例作为研究对象,根据手术入路方法不同分为观察组(眶上外侧入路手术)与对照组(翼点入路手术),每组42例,评估2组患者的临床指标变化与有效率。结果2组患者术前生存质量差异无统计学意义(P>0.05);术后观察组生理领域、躯体限制、社会领域与精神状态评分较对照组高(P<0.05)。手术时间与住院时间较对照组短,切口长度较对照组小,术中出血量较对照组少(P<0.05)。观察手术有效率(97.61%)高于对照组(85.71%),观察组并发症发生率(9.52%)低于对照组(28.57%)(P<0.05)。术前,2组患者的炎性因子IL-12p70、IFN-γ和TNF-α水平比较差异无统计学意义(P>0.05),2组术后IL-12p70、IFN-γ和TNF-α水平均较术前明显升高(P<0.05),而观察组炎性因子IL-12p70、IFN-γ和TNF-α水平明显低于对照组(P<0.05)。结论对急性期颅内前循环破裂动脉瘤患者采用眶上外侧入路手术治疗改善手术效果,提高生存质量。

Objective To study the effect of supraorbital lateral approach and pterional approach on acute intracranial anterior circulation ruptured aneurysms.Methods Eighty-four patients with ruptured intracranial anterior circulation aneurysms in the acute period were admitted to our hospital from November 2017 to June 2019 were selected as the research objects.The patients were randomly divided into observation group(supraorbital lateral approach surgery)and control group(pterional approach surgery)with 42 cases in each group.The change time and effective rate of clinical indicators in the two groups were evaluated.Results There was no significant difference in preoperative quality of life between the two groups(P>0.05).After operation,the physiological field,physical limitation,social field and scores of mental state in the observation group were higher than those in the control group(P<0.05).The operation time and hospitalization time are shorter than those of the control group,the incision length is smaller than that of the control group,and the intraoperative blood loss is less than that of the control group(P<0.05).The effective rate of observation operation(97.61%)was higher than that of control group(85.71%),while the complication rate of observation group(9.52%)was lower than that of control group(28.57%)(P<0.05).The levels of IL-12 p70,IFN-γand TNF-αin the two groups were significantly higher than those before operation(P<0.05).However,the levels of IL-12 p70,IFN-γand TNF-αin the observation group were significantly lower than those in the control group(P<0.05).Conclusion Compared with pterional approach,supraorbital lateral approach for acute intracranial anterior circulation ruptured aneurysms can improve the quality of life and surgical effect.