出血性前循环动脉瘤的显微手术治疗

目的研究出血性前循环动脉瘤的临床特点。方法回顾性分析178例出血性前循环动脉瘤的临床资料。本组Hunt-Hess分级Ⅰ级59例，Ⅱ级41例，Ⅲ级45例，Ⅳ～Ⅴ级33例。采用翼点入路显微镜下手术夹闭前循环脑动脉瘤179个。结果本组前循环动脉瘤均获得夹闭。术后恢复良好133例，生活自理25例，长期昏迷11例，死亡9例。结论尽早手术夹闭动脉瘤可防止其再出血；提高Ⅳ～Ⅴ级病人的生存率是可行的。术中防止动脉瘤再破裂可降低病人的致残率及病死率。

Microsurgery for ruptured anterior circulation aneurysms

Objective To study the clinical features of ruptured aneurysms of anterior circulation. Methods The clinical data of 178 patients suffered from ruptured anterior circulation aneurysms were retrospectively analyzed. In the group, preoperative Hunt and Hess grade was Ⅰ in 59 cases, Ⅱ in 41, Ⅲ in 45, and Ⅳ-Ⅴ in 33. The pterional approach was used for microsurgery in all the cases, and 179 aneurysms were clipped successfully under the microscope. Results After the surgery, good outcome was achieved in 133 cases, mild disability in 25, severe disability in 11, and dead in 9. Conclusion Early surgery by clipping the aneurysms can avoid rehemorrhage. Active treatment is feasible to increase the survival rate of patients with grade Ⅳ or Ⅴ. To prevent intraoperative rupture of aneurysm can decrease the disability rate and mortality.