【摘要】：背景 對患有雙側前循環(huán)動脈瘤的患者,傳統(tǒng)的手術方案是(1)分期手術,一期開顱夾閉破裂側動脈瘤；或者(2)同期雙側開顱動脈瘤夾閉術。理論上,如果對側動脈瘤能夠通過充分暴露,通過單側入路夾閉雙側前循環(huán)動脈瘤將簡化治療過程,患者可以避免再次開顱和重復麻醉的風險。當前已有多項關于單側翼點入路夾閉雙側動脈瘤的報道。眶上外側入路具有微創(chuàng)、美觀、便捷的優(yōu)勢,可能成為雙側動脈瘤夾閉術的一種手術方式。 方法 回顧性分析自2012年8月—2014年12月,于浙江大學醫(yī)學院附屬第二醫(yī)院接受動脈瘤夾閉術的32例雙側前循環(huán)動脈瘤患者臨床資料。按照是否行單側眶上外側入路雙側動脈瘤夾閉術分為Group A(是)和Group B(單側夾閉,需要二期手術)兩組,分別回顧患者性別、年齡、術前HuntHess分級、動脈瘤大小、生長部位、手術時間、住院時間、出院時GOS評分、術后動脈瘤是否殘留、主要并發(fā)癥等信息,比較分析單側眶上外側入路雙側動脈瘤夾閉術的安全性和有效性,分析HuntHess分級、動脈瘤大小、生長部位等因素對患者預后的影響,回顧單側入路手術的臨床應用現(xiàn)狀。 結果 Group A與Group B在性別、年齡、術前HuntHess分級、動脈瘤大小、生長部位、手術時間、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后并發(fā)癥相當；術前HuntHess分級、動脈瘤生長部位可能與單側LSO入路雙側動脈瘤夾閉術的短期預后相關。當前單側翼點入路雙側動脈瘤夾閉術較為成熟。 結論 眶上外側入路作為一種微創(chuàng)、美觀、快捷的手術方式,用于夾閉雙側動脈瘤相對安全、有效�；颊叩亩唐陬A后可能受術前HuntHess分級、動脈瘤部位、瘤體指向、患者顱內條件等因素的影響。單側LSO入路夾閉雙側動脈瘤作為對多發(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.
【學位授予單位】：浙江大學
【學位級別】：博士
【學位授予年份】：2015
【分類號】：R651.1

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本文編號：2316679