不同入路夹闭前循环动脉瘤的临床疗效分析

发布时间：2018-08-13 15:43

【摘要】：目的对比经眶上外侧入路和经眶上锁孔入路夹闭前循环动脉瘤的治疗效果,以指导前循环动脉瘤手术入路的选择。方法回顾性分析2011年1月至2016年1月因自发性蛛网膜下腔出血确诊为前循环动脉瘤80例患者的临床资料,分为经眶上锁孔入路(A组)和眶上外侧入路(B组)。分析两组患者的手术时间、开颅时间、关颅时间、估计术中出血量、手术前后红细胞压积(HCT)改变、术后早期下床活动时间、术后住院时间、入院和出院时格拉斯哥昏迷评分(GCS评分)、出院时格拉斯哥预后评分(GOS评分)的差异并进行文献回顾。结果经眶上外侧入路的手术时间和开颅时间少于经眶上锁孔入路,差异有统计学意义(P0.05)。两组关颅时间、估计术中出血量、手术前后HCT改变、术后早期下床活动时间、术后住院时间、入院和出院时GCS评分、出院时GOS评分差异无统计学意义(P0.05)。结论经眶上外侧入路具有手术时间和关颅时间短,术中能提供更好的手术视野,术中牵拉较少和术后并发症少等优点,在行颅内前循环动脉瘤夹闭术时可作为眶上锁孔入路的替代方案。
[Abstract]:Objective to compare the therapeutic effect of anterior circulation aneurysm clipping via supraorbital lateral approach and supraorbital keyhole approach in order to guide the choice of surgical approach for anterior circulation aneurysm. Methods the clinical data of 80 patients with anterior circulatory aneurysm diagnosed as spontaneous subarachnoid hemorrhage from January 2011 to January 2016 were retrospectively analyzed. The patients were divided into subeorbital keyhole approach (group A) and supraorbital lateral approach (group B). The time of operation, time of craniotomy, time of closing cranium, estimation of intraoperative bleeding, changes of hematocrit (HCT) before and after operation, time of getting out of bed early after operation, time of hospitalization after operation were analyzed. The differences of Glasgow coma score (GCS) at admission and discharge and Glasgow prognosis score (GOS) at discharge were reviewed. Results the operative time and craniotomy time of transorbital lateral approach was less than that of transorbital keyhole approach (P0.05). There was no significant difference between the two groups in the time of cranial closure, the estimated amount of intraoperative bleeding, the changes of HCT before and after operation, the time of getting out of bed early after operation, the time of hospitalization, the GCS score at admission and discharge, and the GOS score at discharge (P0.05). Conclusion Transorbital approach has the advantages of short operative time and closed cranial time, better operative visual field, less traction and less postoperative complications. Intracranial anterior circulation aneurysm clipping can be used as an alternative to supraorbital keyhole approach.
【作者单位】：河南省驻马店市第一人民医院神经外科;郑州大学第二附属医院神经外科;
【基金】：河南省卫生厅科技创新型人才工程基金资助项目(201004126)
【分类号】：R651.12

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