前循环破裂动脉瘤的手术时机

目的 探讨前循环破裂动脉瘤的手术适宜时机.方法 回顾性分析82例前循环破裂动脉瘤患者,按入院时Hunt-Hess分级分为低分级组(Ⅰ～Ⅲ级,n=64)和高分级组(Ⅳ～Ⅴ级,n=18);按手术时机分为早期手术组(≤3 d,n=45)、中期手术组(4～10 d,n=20)、晚期手术组(≥11 d,n=12),5例因再出血未能手术.用格拉斯哥转归量表(Glasgow Outcome Scale,GOS)评价转归.结果 在低分级患者中,早期手术组转归良好(GOS 4～5分)率显著高于中、晚期手术组(96.3%对75%,P=0.031),而术后主要并发症发生率显著低于中晚期手术组(22.2%对46.9%,P=0.049);中期手术组转归良好率显著高于晚期手术组(85.5%对41.7%,P=0.004),术后主要并发症发生率显著低于晚期手术组(30.0%对75.0%,P=0.027).高分级患者均为早期手术,其转归良好率为55.6%.结论 对不同分级的前循环破裂动脉瘤患者宜尽早手术.

The timing of surgery for ruptured anterior circulation aneurysms

Objective To investigate the appropriate timing of surgery for ruptured anterior circulation aneurysms. Methods Eighty-two patients with ruptured anterior circulation aneurysms were analyzed retrospectively. They were divided into the low-grade group (grade Ⅰ to Ⅲ, n =64) and the high-grade group (grade Ⅳ to Ⅴ, n = 18) according to the Hunt & Hess scale on admission. Then they were also divided into early (≤3 d, n = 45), intermediate (4-10 d, n = 20) and late (≥11 d, n = 12) surgery groups according to their timing of surgery. Surgery were not performed in 5 patients for rebleeding. The outcome at 3 months was scored according to the Glasgow Outcome Scale (GOS). Results In the low-grade group, the rate of good outcome (GOS 4-5) in the early surgery group was significantly higher than that in the intermediate and late surgery groups (96. 3% vs. 75. 0%, P =0. 031), and the incidence of the major postoperative complications was significantly lower than that in the intermediate, and late surgery groups (22. 2% vs. 46. 9%, P =0. 049); the rate of good outcome in the intermediate surgery group was significantly higher than that in the late surgery group (85. 5% vs. 41. 7%, P =0. 004), and the incidence of the major postoperative complications was significantly lower than that in the late surgery group (30. 0% vs. 75. 0%, P = 0. 027). The patients in the high-grade group were all operated early, and their rate of good outcome was 55. 6%. Conclusions Early operation is advocated in patients with ruptured anterior circulation aneurysms of different