血管内介入栓塞治疗后交通动脉瘤伴动眼神经麻痹患者的效果及对其预后的影响

Efficacy and Prognosis of Communicating Artery Aneurysm Patients with Oculomotor Nerve Palsy after Endovascular Interventional Embolization

目的:探讨血管内介入栓塞治疗后交通动脉瘤(PcomAA)伴动眼神经麻痹(OMNP)患者的效果及对其预后的影响。方法:回顾性分析2020年3月-2021年9月武汉市新洲区人民医院收治的80例PcomAA伴OMNP患者,根据手术方式不同分为对照组和观察组,各40例。对照组行显微夹闭术,观察组行血管内介入栓塞术。比较两组的围手术期指标、动眼神经恢复情况、血清指标、并发症及预后情况。结果:观察组手术时间、术后气管导管拔管时间短于对照组,术中出血量少于对照组(P<0.05)。两组的动眼神经恢复率比较,差异无统计学意义(P>0.05)。术后3个月,观察组的血清神经元特异性烯醇化酶(NSE)水平低于对照组(P<0.05)。观察组的并发症发生率低于对照组(P<0.05)。观察组恢复良好率高于对照组(P<0.05),两组的其余生存状态比较,差异无统计学意义(P>0.05)。结论:显微夹闭术或血管内介入栓塞术治疗PcomAA伴OMNP,均可有效缓解患者的动眼神经麻痹,但介入术可减少术中出血、缩短手术耗费时间,且能减少神经元损伤,且术后并发症更少,预后更佳。

Objective:To investigate the effect of endovascular interventional embolization in the treatment of posterior communicating artery aneurysm(PcomAA)patients with oculomotor nerve palsy(OMNP)and its influence on prognosis.Method:A total of 80 patients with PcomAA and OMNP who were treated in Xinzhou District People’s Hospital of Wuhan from March 2020 to September 2021 were analyzed retrospectively.According to different surgical method,they were divided into control group and observation group,with 40 cases in each group.The control group underwent micro clamping,while the observation group underwent endovascular interventional embolization.The perioperative indexes,oculomotor nerve recovery,serum indexes,complications and prognosis were compared between the two groups.Result:The operation time and postoperative tracheal intubation time in the observation group were shorter than those in the control group,and the intraoperative blood loss was less than that in the control group(P<0.05).There was no significant difference in the recovery rate of oculomotor nerve between the two groups(P>0.05).Three months after operation,the serum neuron-specific enolase(NSE)level in the observation group was lower than that in the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group(P<0.05).The recovery rate in the observation group was higher than that in the control group(P<0.05),and there were no significant differences in the remaining survival status between the two groups(P>0.05).Conclusion:Micro clamping or endovascular interventional embolization in the treatment of PcomAA with OMNP can effectively relieve the oculomotor nerve palsy in patients,but interventional surgery can reduce intraoperative bleeding,shorten operation time,and reduce neuronal damage.And fewer postoperative complications,which has better prognosis.