發(fā)布時間：2018-11-07 14:42

【摘要】：背景 對患有雙側(cè)前循環(huán)動脈瘤的患者,傳統(tǒng)的手術(shù)方案是(1)分期手術(shù),一期開顱夾閉破裂側(cè)動脈瘤；或者(2)同期雙側(cè)開顱動脈瘤夾閉術(shù)。理論上,如果對側(cè)動脈瘤能夠通過充分暴露,通過單側(cè)入路夾閉雙側(cè)前循環(huán)動脈瘤將簡化治療過程,患者可以避免再次開顱和重復(fù)麻醉的風(fēng)險。當(dāng)前已有多項關(guān)于單側(cè)翼點入路夾閉雙側(cè)動脈瘤的報道�？羯贤鈧�(cè)入路具有微創(chuàng)、美觀、便捷的優(yōu)勢,可能成為雙側(cè)動脈瘤夾閉術(shù)的一種手術(shù)方式。 方法 回顧性分析自2012年8月—2014年12月,于浙江大學(xué)醫(yī)學(xué)院附屬第二醫(yī)院接受動脈瘤夾閉術(shù)的32例雙側(cè)前循環(huán)動脈瘤患者臨床資料。按照是否行單側(cè)眶上外側(cè)入路雙側(cè)動脈瘤夾閉術(shù)分為Group A(是)和Group B(單側(cè)夾閉,需要二期手術(shù))兩組,分別回顧患者性別、年齡、術(shù)前HuntHess分級、動脈瘤大小、生長部位、手術(shù)時間、住院時間、出院時GOS評分、術(shù)后動脈瘤是否殘留、主要并發(fā)癥等信息,比較分析單側(cè)眶上外側(cè)入路雙側(cè)動脈瘤夾閉術(shù)的安全性和有效性,分析HuntHess分級、動脈瘤大小、生長部位等因素對患者預(yù)后的影響,回顧單側(cè)入路手術(shù)的臨床應(yīng)用現(xiàn)狀。 結(jié)果 Group A與Group B在性別、年齡、術(shù)前HuntHess分級、動脈瘤大小、生長部位、手術(shù)時間、住院時間、出院時GOS評分等方面無顯著差異,動脈瘤殘留情況與術(shù)后并發(fā)癥相當(dāng)；術(shù)前HuntHess分級、動脈瘤生長部位可能與單側(cè)LSO入路雙側(cè)動脈瘤夾閉術(shù)的短期預(yù)后相關(guān)。當(dāng)前單側(cè)翼點入路雙側(cè)動脈瘤夾閉術(shù)較為成熟。 結(jié)論 眶上外側(cè)入路作為一種微創(chuàng)、美觀、快捷的手術(shù)方式,用于夾閉雙側(cè)動脈瘤相對安全、有效�；颊叩亩唐陬A(yù)后可能受術(shù)前HuntHess分級、動脈瘤部位、瘤體指向、患者顱內(nèi)條件等因素的影響。單側(cè)LSO入路夾閉雙側(cè)動脈瘤作為對多發(fā)動脈瘤治療方式的探索和創(chuàng)新,值得進(jìn)一步推廣。
[Abstract]:Background for patients with bilateral anterior circulatory aneurysms, the traditional surgical procedures are (1) stage operation, one stage clipping of ruptured aneurysms, or (2) bilateral clipping of aneurysms. Theoretically, if the contralateral aneurysm can be fully exposed, clipping bilateral anterior circulation aneurysms through a unilateral approach will simplify the treatment process, and patients can avoid the risk of re-craniotomy and repeated anesthesia. There have been many reports of single-flanking approach clipping bilateral aneurysms. The supraorbital approach has the advantages of minimally invasive, beautiful and convenient, and may become a surgical method for bilateral aneurysm clipping. Methods from August 2012 to December 2014, the clinical data of 32 patients with bilateral anterior circulation aneurysm underwent clipping in the second affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. According to whether or not bilateral aneurysm clipping via unilateral supraorbital approach was performed, the patients were divided into Group A (group and Group B (unilateral clipping group. The patients' sex, age, preoperative HuntHess grade, aneurysm size, growth site were reviewed respectively. The time of operation, the time of hospitalization, the GOS score at discharge, whether the aneurysm remained or not, the main complications were compared and analyzed. The safety and effectiveness of bilateral aneurysm clipping with unilateral supraorbital approach were compared and analyzed. The HuntHess grade and the size of aneurysm were analyzed. The clinical application of unilateral approach was reviewed. Results there were no significant differences between Group A and Group B in sex, age, preoperative HuntHess grade, aneurysm size, growth site, operation time, hospitalization time and GOS score at discharge. Preoperative HuntHess classification and the location of aneurysm may be related to the short-term prognosis of bilateral aneurysm clipping via unilateral LSO approach. At present, bilateral aneurysm clipping via single flanking approach is more mature. Conclusion the supraorbital approach is a minimally invasive, beautiful and rapid surgical approach, which is relatively safe and effective in clipping bilateral aneurysms. The short-term prognosis of the patients may be affected by preoperative HuntHess grade, aneurysm location, tumor direction and intracranial conditions. Unilateral LSO approach clipping bilateral aneurysms as the treatment of multiple aneurysms exploration and innovation, worthy of further promotion.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R651.1

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本文編號：2316679