改良眶翼点入路开颅治疗前交通动脉瘤破裂的疗效优势

Advantages of modified supraorbital pterional craniotomy in treatment of anterior communicating artery aneurysm rupture

目的分析改良眶翼点入路进行开颅手术治疗前交通动脉瘤破裂的疗效。方法回顾性分析湖北医药学院附属襄阳市第一人民医院收治的134例前交通动脉瘤破裂患者的临床资料,根据手术路径的不同分为对照组(左侧翼点入路进行开颅手术)和观察组(改良眶翼点入路进行开颅手术),每组67例。比较2组患者出院后6个月的神经恢复情况,比较2组患者手术前后(术前、术后1 d、出院后1个月、出院后6个月)髓鞘碱性蛋白(MBP)、神经元特异性烯醇化酶(NSE)、中枢神经特异性蛋白(S100β)含量及Barthel指数差异,比较2组患者术后6个月内不良事件发生情况。结果观察组患者出院后6个月神经恢复情况显著优于对照组,中残和重残患者人数显著少于对照组,2组比较差异具有统计学意义(P<0.05)。随着时间迁移,2组患者MBP、NSE、S100β指标含量及Barthel指数均显著上升,组内不同时点比较差异有统计学意义(P<0.05);出院后1、6个月,观察组患者MBP、NSE、S100β指标含量显著低于对照组,Barthel指数显著高于对照组,差异具有统计学意义(P<0.05)。观察组患者术后6个月病死率显著低于对照组,2组比较差异具有统计学意义(P<0.05)。结论采用改良眶翼点入路开颅治疗前交通动脉瘤破裂的临床效果优异,可广泛应用于临床。

Objective To analyze the effect of modified supraorbital pterygoid approach in craniotomy for anterior communicating artery aneurysm rupture.Methods A retrospective analysis was performed on 134 patients with anterior communicating artery aneurysm rupture in Xiangyang first people′s hospital affiliated to Hubei university of medicine, who were divided into the control group (left pterional approach for craniotomy) and the observation group (modified supraorbital pterional approach for craniotomy) according to the different surgical paths,with 67 patients in each group. The neurological recovery at 6 months after discharge was compared between the two groups,the myelin basic protein(MBP)(before and 1 day after surgery,1 month and 6 months after discharge),neuron-specific enolase(NSE),S100β,Barthel index and adverse event(within 6 months after surgery) were compared between the two groups. Results The neurological recovery of patients in the observation group at 6 months after discharge was significantly better than that of the control group,and the number of patients with moderate and severe disability was significantly less than that of the control group,the differences were significant( P <0.05).The levels of MBP,NSE and S100β and the Barthel index in both groups increased with time, the differences at different time points in the groups were statistically significant( P <0.05).The levels of MBP,NSE and S100β at 1 month and 6 months after discharge in the observation group were lower than those in the control group,while Barthel index was higher than that in control group,the differences were significantly( P <0.05). The mortality of patients at 6 months after surgery in the observation group was lower than that in the control group,the difference was significant( P <0.05 ). Conclusion Modified supraorbital pterional craniotomy is effective in the treatment of anterior communicating aneurysm rupture,it can be widely used in clinical treatment.