前循环动脉瘤夹闭术中不同破裂点对患者预后的影响

目的探讨颅内前循环动脉瘤夹闭术中动脉瘤破裂(IAR)的不同破裂点(瘤体、瘤颈及瘤顶)对患者手术预后的影响。方法对2009年5月—2012年3月连续纳入的135例(148个动脉瘤)接受显微动脉瘤夹闭术患者的临床资料进行回顾性分析,对术后患者的预后评价采用格拉斯哥预后量表(GOS)进行评定。将发生IAR动脉瘤的不同破裂点作为影响因素,并对其与IAR患者不同预后之间的关系进行分析。结果 135例患者的148个动脉瘤夹闭术中,30例患者的31个动脉瘤发生术中破裂(占动脉瘤20.9%,占患者22.2%),其中破裂点发生在动脉瘤顶部9个、体部17个及颈部5个。17例患者GOS评分5分,8例4分,2例3分,1例2分,2例1分;预后良好者共25例,预后不良者共5例。IAR不同破裂点对于IAR患者预后的影响差异有统计学意义(OR=1.273,95%CI:6.764~18.344,P=0.006),其中25例瘤体、顶部破裂者中1例预后不良,5例瘤颈部破裂者中4例预后不良。结论前循环动脉瘤夹闭术中动脉瘤破裂点对于IAR患者预后可产生明显影响,其中瘤颈部破裂是导致患者不良预后的主要因素。

Impact of the different rupture points on the prognosis of patients in anterior circulation aneurysm clipping

Objective To investigate the impact of the different rupture points （ sac, neck, and top） of intraoperative aneurysm rupture （IAR） on the prognosis of patients in anterior circulation aneurysm clipping. Methods The clinical data of 135 consecutive patients （148 aneurysms） accepted microsurgical aneurysm clipping from May 2009 to March 2012 were analyzed retrospectively. The prognostic evaluation of the patients after procedure was assessed by using the Glasgow outcome scale （GOS）. The different aneurysm rupture points of IAR were used as influencing factors, and the relationship between the different rupture points and the prognosis of patients was analyzed. Results During clipping of 148 aneurysms in 135 patients,31 aneurysms in 30 patients had intraoperative rupture （20.9% of the aneurysms, 22. 2% of the patients）. Nine rupture points occurred on the top of aneurysms, 17 occurred on the sac,and 5 occurred on neck. The Glasgow outcome scale （GOS） scores 5,4,3,2 and 1 were in 17,8,2,1 and 2 patients, respectively. A total of 25 patients had good prognosis and 5 cases had poor prognosis. There were no significant differences in the impact of different rupture points of IAR on the prognosis in patients of IAR （ OR, 100.00,95% confidence interval 6.764 -18. 344,P =0. 006）. Of the 25 patients with aneurysm sac or top rupture,1 case had poor prognosis. Of the 5 patients with aneurysm neck rupture, 4 cases had poor prognosis. Conclusion In anterior circulation aneurysm clipping, the different aneurysm rupture points may have significant impact on the prognosis of patients,the aneurysm neck ruptureis a main factor for resulting in the poor prognosis of patients.