单侧眶上外侧入路夹闭双侧前循环动脉瘤病例分析及文献回顾

发布时间：2018-11-07 14:42

【摘要】：背景对患有双侧前循环动脉瘤的患者,传统的手术方案是(1)分期手术,一期开颅夹闭破裂侧动脉瘤；或者(2)同期双侧开颅动脉瘤夹闭术。理论上,如果对侧动脉瘤能够通过充分暴露,通过单侧入路夹闭双侧前循环动脉瘤将简化治疗过程,患者可以避免再次开颅和重复麻醉的风险。当前已有多项关于单侧翼点入路夹闭双侧动脉瘤的报道。眶上外侧入路具有微创、美观、便捷的优势,可能成为双侧动脉瘤夹闭术的一种手术方式。方法回顾性分析自2012年8月—2014年12月,于浙江大学医学院附属第二医院接受动脉瘤夹闭术的32例双侧前循环动脉瘤患者临床资料。按照是否行单侧眶上外侧入路双侧动脉瘤夹闭术分为Group A(是)和Group B(单侧夹闭,需要二期手术)两组,分别回顾患者性别、年龄、术前HuntHess分级、动脉瘤大小、生长部位、手术时间、住院时间、出院时GOS评分、术后动脉瘤是否残留、主要并发症等信息,比较分析单侧眶上外侧入路双侧动脉瘤夹闭术的安全性和有效性,分析HuntHess分级、动脉瘤大小、生长部位等因素对患者预后的影响,回顾单侧入路手术的临床应用现状。结果 Group A与Group B在性别、年龄、术前HuntHess分级、动脉瘤大小、生长部位、手术时间、住院时间、出院时GOS评分等方面无显著差异,动脉瘤残留情况与术后并发症相当；术前HuntHess分级、动脉瘤生长部位可能与单侧LSO入路双侧动脉瘤夹闭术的短期预后相关。当前单侧翼点入路双侧动脉瘤夹闭术较为成熟。结论眶上外侧入路作为一种微创、美观、快捷的手术方式,用于夹闭双侧动脉瘤相对安全、有效。患者的短期预后可能受术前HuntHess分级、动脉瘤部位、瘤体指向、患者颅内条件等因素的影响。单侧LSO入路夹闭双侧动脉瘤作为对多发动脉瘤治疗方式的探索和创新,值得进一步推广。
[Abstract]:Background for patients with bilateral anterior circulatory aneurysms, the traditional surgical procedures are (1) stage operation, one stage clipping of ruptured aneurysms, or (2) bilateral clipping of aneurysms. Theoretically, if the contralateral aneurysm can be fully exposed, clipping bilateral anterior circulation aneurysms through a unilateral approach will simplify the treatment process, and patients can avoid the risk of re-craniotomy and repeated anesthesia. There have been many reports of single-flanking approach clipping bilateral aneurysms. The supraorbital approach has the advantages of minimally invasive, beautiful and convenient, and may become a surgical method for bilateral aneurysm clipping. Methods from August 2012 to December 2014, the clinical data of 32 patients with bilateral anterior circulation aneurysm underwent clipping in the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. According to whether or not bilateral aneurysm clipping via unilateral supraorbital approach was performed, the patients were divided into Group A (group and Group B (unilateral clipping group. The patients' sex, age, preoperative HuntHess grade, aneurysm size, growth site were reviewed respectively. The time of operation, the time of hospitalization, the GOS score at discharge, whether the aneurysm remained or not, the main complications were compared and analyzed. The safety and effectiveness of bilateral aneurysm clipping with unilateral supraorbital approach were compared and analyzed. The HuntHess grade and the size of aneurysm were analyzed. The clinical application of unilateral approach was reviewed. Results there were no significant differences between Group A and Group B in sex, age, preoperative HuntHess grade, aneurysm size, growth site, operation time, hospitalization time and GOS score at discharge. Preoperative HuntHess classification and the location of aneurysm may be related to the short-term prognosis of bilateral aneurysm clipping via unilateral LSO approach. At present, bilateral aneurysm clipping via single flanking approach is more mature. Conclusion the supraorbital approach is a minimally invasive, beautiful and rapid surgical approach, which is relatively safe and effective in clipping bilateral aneurysms. The short-term prognosis of the patients may be affected by preoperative HuntHess grade, aneurysm location, tumor direction and intracranial conditions. Unilateral LSO approach clipping bilateral aneurysms as the treatment of multiple aneurysms exploration and innovation, worthy of further promotion.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R651.1

【参考文献】