复合手术与常规夹闭术治疗颈内动脉后交通动脉破裂动脉瘤的疗效对比研究

目的 对比研究复合手术和常规夹闭术治疗颈内动脉后交通动脉破裂动脉瘤的疗效。方法 60例颈内动脉后交通动脉破裂动脉瘤随机分成复合组和对照组，每组30例。复合组患者术中在实时造影技术及球囊临时阻断技术辅助下完成对动脉瘤的夹闭，对照组患者在显微镜下进行开颅动脉瘤夹闭术，比较两组患者术后疗效的差异。结果 复合组动脉瘤完全夹闭率（100%）与对照组（86.7%）无明显差异（P>0.05）。复合组术中动脉瘤破裂率（3.3%）、术后动脉瘤复发率（0%）、术后颅内血肿发生率（0%）、术后偏瘫发生率（0%）均显著低于对照组（分别为26.7%、12.0%、16.7%和16.7%；P<0.05）。出院时，按gos评分评估预后，复合组恢复良好23例，中残5例，重残2例；对照组恢复良好14例，中残5例，重残7例，植物生存2例，死亡2例；复合组预后明显优于对照组（>P<0.05）。>结论 与常规夹闭术相比，复合手术能明显改善颈内后交通动脉破裂动脉瘤的预后，提高手术安全性，降低术后并发症的发生率。

Analysis of the effects of hybrid surgery on posterior communicating artery aneurysms: a comparison with conventional craniotomy

Objective To evaluate the role of hybrid surgery in clipping of posterior communicating artery (PCA) aneurysms and its effect on PCA aneurysms. Methods Sixty patients with PCA aneurysms were randomly divided into hybrid surgery group (n=30) and conventional craniotomy group (n=30). The PCA aneurysms were clipped by microsurgery with the help of intraoperative real-time digital substraction angiography and balloon temporary occlusion of parent arteries in the hybrid surgery group. The intracranial aneurysms were clipped only by conventional microsurgery in the conventional craniotomy group. The curative effect were analyzed in the two groups and compared with each other. Results There was no sinificant difference in the rate of complete occlusion of aneurysm between hybrid surgery group and conventional craniotomy group (100.0% vs 86.7%; P>0.05). The rates of aneurysms rupture (3.3%) and aneurysms recurrence after the operation (0%) and hemiplegia (0%) were significantly lower in hybrid surgery group than those [26.7%, 12.0% and 16.7%, respectively] in conventional craniotomy group (P<0.05). the="" prognosis="" was="" significantly="" better="" in="" hybrid="" surgery="" group="" than="" that="" conventional="" craniotomy="" (P<0.01).>Conclusions The hybrid surgery, which can significantly improve the prognoses and operative safety and reduce the incidence of postoperative complications, is a safe and effective method to treat PCA aneurysms.