颅内前循环动脉瘤破裂后中晚期手术的疗效分析

目的 比较颅内前循环动脉瘤破裂中、晚期显微手术夹闭的疗效并探讨中期治疗(4-10 d)的可行性.方法 回顾性分析了95例前循环动脉瘤破裂出血后4-10 d入院,且入院时Hunt-Hess分级Ⅰ～Ⅲ的患者,41例接受中期动脉瘤手术夹闭,54例接受晚期手术夹闭(11-30 d),以改良Rankin量表评分对患者预后进行评分.结果 出院后6个月,中期组30例(73.2%)患者预后良好(mRS 0～2级),而晚期组为42例(77.8%),两组差异无统计学意义.导致预后不良的最主要原因为动脉瘤破裂再出血.结论 颅内前循环动脉瘤破裂中期,积极闭塞动脉瘤可为患者获得良好的预后创造条件,尤其是临床状况良好的患者.

Clinical effect of treatment on patients with ruptured intracranial suprutentorial aneurysms during the intermediate period or delayed period

Objective To compare the effect of microsurgery for ruptured intracranial supratentorial uneurysms during intermediate period versus delayed period and to evaluate the feasibility of surgical clipping during intermediate period. Method A retrospective analysis of 95 patients with Hunt-Hess Grade Ⅰ～Ⅲ on admission who were admitted 4 to 10 days after initial supratentorial aneurysmal subarachnoid haemorrhage. Forty-one patients underwent intermediate clipping while 54 patients accepted delayed obliteration of ruptured aneurysm (days 11-30). Outcome after 6 months was assessed using Modified Rankin Scale(mRS). Results There was no difference in outcome between two groups according to mRS at 6 months follow-up. Thirty patients(73.2%) in the intermediate group and 42 patients(77.8%) in the late group had a favorable functional outcome with a mRS score of 0 to 2. In 39.1% of the 23 patients who had poor outcome, rebleeding before active treatment was the leading factor contributing to poor outcome. Conclusions Surgical clipping of ruptured intracranial aneurysms during intermediate period provided good opportunity for patients to achieve favorable outcomes especially for those in good clinical condition.