摘要
目的:分析显微夹闭与介入栓塞治疗伴动眼神经麻痹(oculomotor never palsy,ONP)的颈内-后交通动脉瘤(internal carotid-posterior communication artery aneurysm,IC-PcomA)患者术后ONP恢复情况,并对影响ONP恢复因素进行分析。方法:回顾性分析重庆医科大学附属第一医院神经外科50例伴ONP的IC-PcomA患者,其中行显微夹闭手术37例,介入栓塞治疗13例,对不同手术后3个月、6个月后ONP恢复程度进行对比。并对患者年龄、性别、高血压、糖尿病、动脉瘤有无破裂、治疗间隔、麻痹程度、动脉瘤直径、Hunt-Hess分级、手术方式与术后ONP恢复程度进行多因素logistic回归分析。结果:单因素分析术前各因素,治疗间隔对ONP术后恢复有统计学意义(P<0.05);再进行logistic回归分析,治疗间隔是术后恢复的独立影响因素(P<0.05),OR为0.134(0.034,0.528),回归系数为-2.009,治疗间隔与治疗效果呈负相关,其余因素未见明显统计学差异(P>0.05)。术后3个月时,夹闭组OPN的完全恢复率(62.16%)高于介入组(38.46%),夹闭组部分恢复率(27.03%)较介入组(46.15%)低,2组比较无统计学差异(P>0.05),手术6个月后夹闭组的完全恢复率(75.68%)高于介入组(61.54%),夹闭组部分恢复率(13.51%)低于介入组(23.08%),2组比较无统计学差异(P>0.05)。结论:显微夹闭和介入栓塞均能有效改善IC-PcomA的ONP症状,总体恢复情况无统计学差异(P>0.05)。治疗间隔是术后ONP完全恢复的独立影响因素,治疗间隔越短,完全恢复率越高。
Objective:To compare the recovery from oculomotor never palsy(ONP)following microsurgical clipping versus endovascular coiling for internal carotid-posterior communicating artery aneurysm(IC-PcomA),and to analyze the factors that affect ONP recovery.Methods:The clinical data of 50 patients with ONP secondary to IC-PcomA were reviewed. Of these 50 patients,37 underwent microsurgical clipping and 13 underwent endovascular coiling. ONP recovery at 3 months and 6 months post-surgery was compared between the two groups. In addition,age,gender,hypertension,diabetes,presence or absence of aneurysm rupture,treatment interval,degree of paralysis,aneurysm diameter,Hunt-Hess classification,surgical procedure,and postoperative ONP recovery were subjected to multivariate logistic regression analysis. Results:Univariate analysis of various preoperative factors showed that treatment interval had a significant impact on postoperative ONP recovery(P<0.05). Further logistic regression analysis demonstrated that treatment interval was an independent factor affecting postoperative ONP recovery(P<0.05,odds ratio =0.134[0.034-0.528],regression coefficient=-2.009)and treatment interval was negatively correlated with treatment efficacy. There were no significant correlations between treatment efficacy and other factors(all P>0.05). At 3 months post-surgery,the microsurgical clipping group had a higher complete ONP recovery rate(62.16%)and a lower partial ONP recovery rate(27.03%) compared with the endovascular coiling group(38.46% and 46.15%,respectively),but the differences were not statistically significant(both P>0.05). Similarly,at 6 months post-surgery,the microsurgical clipping group had a higher complete ONP recovery rate(75.68%) and a lower partial ONP recovery rate(13.51%)than the endovascular coiling group(61.54% and 23.08%,respectively),but the differences were not statistically significant(both P>0.05). Conclusion:Both microsurgical clipping and endovascular coiling can effectively improve ONP in IC-PcomA,and overall ONP recovery is similar between the two procedures. Treatment interval is an independent factor affecting complete postoperative ONP recovery,where shorter treatment interval leads to higher complete recovery rate.
作者
薛莘
朱继
郭宗铎
徐睿
张晓冬
孙晓川
Xue Xin;Zhu Ji;Guo Zongduo;Xu Rui;Zhang Xiaodong;Sun Xiaochuan(Department of Neurosurgery,The First Affiliated Hospital of Chongqing Medical University)
出处
《重庆医科大学学报》
CAS
CSCD
北大核心
2020年第1期106-110,共5页
Journal of Chongqing Medical University
基金
重庆市卫计委医学科研资助项目(编号:2016MSXM015)。
关键词
动眼神经麻痹
颈内-后交通动脉瘤
介入栓塞
显微夹闭
术后恢复
oculomotor nerve palsy
internal carotid-posterior communicating artery aneurysm
endovascular coiling
microsurgical clipping