颅内动脉瘤1 041例显微手术治疗临床研究

目的：探讨不同类型动脉瘤显微手术方法以及影响手术预后的因素。方法：分析1988-2001年1041例颅内动脉瘤显微手术治疗效果,其中手术夹闭982例（94.3％）,孤立术32例（3.1％）,包裹术27例（2.6％）。结果：多发动脉瘤93例（8.9％）。动脉瘤部位：后交通动脉瘤357个（31.2％）,前交通动脉瘤261个（22.8％）,颈内动脉瘤210个（18.4％）,大脑中动脉瘤158个（13.8％）,大脑前动脉瘤63个（5.5％）,椎基底动脉瘤59个（5.2％）,大脑后动脉瘤35个（3.1％）。手术死亡率1.8％。动脉瘤夹闭后复查脑血管造影,动脉瘤消失978例（99.6％）。结论：手术夹闭动脉瘤是较理想手术治疗手段。微创神经外科可显著提高动脉瘤手术效果。患者年龄、手术前分级、动脉瘤直径以及术中动脉瘤是否破裂一预后密切相关。

Microsurgery for intracranial aneurysm,clinical analysis of 1,041 cases

OBJECTIVE: To study the effect of microsurgery on incranial aneurysm and factors influential in prognosis. METHODS: A retrospective analysis was made on the clinical data of 1,041 patients, 505 males and 536 females, aged 44.2 +/- 12.6, with incranial aneurysm treated by microsurgery 1988 approximately 2001, including clipping of aneurysm (982 cases, 94.3%), isolating of the aneurysm (32 cases, 3.1%), and coating of the aneurysm (27 cases, 2.6%). RESULTS: 93 patients (8.9%) had multiple aneurysms. 357 aneurysms (31.2%) were in the posterior communicating artery, 261 (22.8%) in the anterior communicating artery, 210 (18.4%) in the internal carotid artery, 158 (13.8%) in the middle cerebral artery, 63 (5.5%) in the anterior cerebral artery, 59 (5.2%) in the vertebral-basilar artery, and 35 (3.1%) in the posterior cerebral artery. The overall operative mortality was 1.8%. Angiography performed post-operationally showed that the aneurysm was occluded in 978 patients (99.6%). The prognosis was related to the age of patient (P = 0.001), Hunt and Hess grading before operation (P = 0.001), diameter of aneurysm (P = 0.000), and whether the aneurysm ruptures during operation (P = 0.006), and was not related to the gender of patient (P = 0.059). CONCLUSION: Clipping of the aneurysm is considered the best treatment. Microinvasive neurosurgery has improved significantly the effect of treatment of intracranial aneurysm. Factors influencing prognosis after operation include the age of patient, Hunt and Hess grading before operation, diameter of aneurysm, and whether the aneurysm ruptures during operation.