[1]曾　春　张施远　蒋永明.复合手术与常规夹闭术治疗颈内动脉后交通动脉破裂动脉瘤的疗效对比研究[J].中国临床神经外科杂志,2016,(05):257-260.[doi:10.13798/j.issn.1009-153X.2016.05.001]
　ZENG Chun,ZHANG Shi-yuan,JIANG Yong-ming.Analysis of the effects of hybrid surgery on posterior communicating artery aneurysms: a comparison with conventional craniotomy[J].,2016,(05):257-260.[doi:10.13798/j.issn.1009-153X.2016.05.001]
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复合手术与常规夹闭术治疗颈内动脉后交通动脉破裂 动脉瘤的疗效对比研究()
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《中国临床神经外科杂志》[ISSN:1009-153X/CN:42-1603/TN]

卷:
期数:
2016年05期
页码:
257-260
栏目:
论著
出版日期:
2016-05-25

文章信息/Info

Title:
Analysis of the effects of hybrid surgery on posterior communicating artery aneurysms: a comparison with conventional craniotomy
文章编号:
1009-153X（2016）05-0257-04
作者:
曾　春　张施远　蒋永明
作者单位：629000 四川，遂宁市中心医院神经外科（曾　春、张施远、蒋永明）
Author(s):
ZENG Chun;  ZHANG Shi-yuan;  JIANG Yong-ming
Department of Neurosurgery, Central Hospital of Suining City, Suining 629000, China
关键词:
颅内动脉瘤; 颈内动脉后交通动脉; 术中造影; 复合手术; 夹闭术; 疗效
Keywords:
Intracranial aneurysm;  Posterior communicating artery;  Intraoperative angiography;  Hybrid surgery;  Curative effect
分类号:
R 743.9; R 651.1+1
DOI:
10.13798/j.issn.1009-153X.2016.05.001
文献标志码:
A
摘要:
目的 对比研究复合手术和常规夹闭术治疗颈内动脉后交通动脉破裂动脉瘤的疗效。方法 60例颈内动脉后交通动脉破裂动脉瘤随机分成复合组和对照组，每组30例。复合组患者术中在实时造影技术及球囊临时阻断技术辅助下完成对动脉瘤的夹闭，对照组患者在显微镜下进行开颅动脉瘤夹闭术，比较两组患者术后疗效的差异。结果 复合组动脉瘤完全夹闭率（100%）与对照组（86.7%）无明显差异（P>0.05）。复合组术中动脉瘤破裂率（3.3%）、术后动脉瘤复发率（0%）、术后颅内血肿发生率（0%）、术后偏瘫发生率（0%）均显著低于对照组（分别为26.7%、12.0%、16.7%和16.7%；P<0.05）。出院时，按gos评分评估预后，复合组恢复良好23例，中残5例，重残2例；对照组恢复良好14例，中残5例，重残7例，植物生存2例，死亡2例；复合组预后明显优于对照组（>P<0.05）。>结论 与常规夹闭术相比，复合手术能明显改善颈内后交通动脉破裂动脉瘤的预后，提高手术安全性，降低术后并发症的发生率。
Abstract:
Objective To evaluate the role of hybrid surgery in clipping of posterior communicating artery (PCA) aneurysms and its effect on PCA aneurysms. Methods Sixty patients with PCA aneurysms were randomly divided into hybrid surgery group (n=30) and conventional craniotomy group (n=30). The PCA aneurysms were clipped by microsurgery with the help of intraoperative real-time digital substraction angiography and balloon temporary occlusion of parent arteries in the hybrid surgery group. The intracranial aneurysms were clipped only by conventional microsurgery in the conventional craniotomy group. The curative effect were analyzed in the two groups and compared with each other. Results There was no sinificant difference in the rate of complete occlusion of aneurysm between hybrid surgery group and conventional craniotomy group (100.0% vs 86.7%; P>0.05). The rates of aneurysms rupture (3.3%) and aneurysms recurrence after the operation (0%) and hemiplegia (0%) were significantly lower in hybrid surgery group than those [26.7%, 12.0% and 16.7%, respectively] in conventional craniotomy group (P<0.05). the="" prognosis="" was="" significantly="" better="" in="" hybrid="" surgery="" group="" than="" that="" conventional="" craniotomy="" (P<0.01).>Conclusions The hybrid surgery, which can significantly improve the prognoses and operative safety and reduce the incidence of postoperative complications, is a safe and effective method to treat PCA aneurysms.

参考文献/References:

[1] Pera J, Korostynski M, Krzyszkowski T. Gene expression profiles in human ruptured and unruptured intracranial aneurysms: what is the role of infla mmation [J]? Stroke, 2010, 41(2): 224-226.
[2] Roos YB, de Haan RJ, Beenen LF, et al. Complications and outcome in patients with aneurysmal subarachnoid heamo- rrhage: a prospective hospital based cohort study in the Netherlands [J]. J Neurol Neurosurg Psychiatry, 2000, 68 (3): 337-341.
[3] Colby GP, Coon AL, Tamargo RJ. Surgical management of aneurismal subarachnoid hemorrhage [J]. Neurosurg Clin N Am, 2010, 21(2): 247-261.
[4] Britz GW, Clipping or coiling of cerebral aneurysms [J]. Neurosurg Clin N Am, 2005, 16(3): 475-485.
[5] Akdemir H, Oktem IS, Tucer B, et al. Interoperative micro- vascular Doppler sonography in aneurysm surgery [J]. Minim Invasive Neurosurg, 2006, 49(5): 312-316.
[6] Kang DZ, Wu ZY, Lan Q, et al. Combined monitoring of evoked potentials during mierosurgery for lesions adjacent to the brainstem and intracranial aneurysms [J]. Chin Med J, 2007, 120：1567-1573.
[7] Imizu S, Kato Y, Sangli A, et al. Assessment of incomplete clipping of aneurysms intraoperatively by a near-in-frared indocyanine green-video angiography(Niicg-Va) integrated microscope [J]. Minim Invasive Neurosurg, 2008, 51: 199- 203.
[8] 李爱国，李志立，杨露曦，等. 术中微血管超声多普勒在颅 内动脉瘤夹闭术中的作用及疗效[J]. 重庆医学，2014，43 （18）：2272-2277.
[9] Fandino J, Taussky P, Marbacher S, et al. The concept of a hybrid operating room: applications in cerebrovascular surgery [J]. Acta Neurochir Suppl, 2013, 115: 113-117.
[10] Batjer H, Samson D. intraoperative aneurysmal rupture: in- cidence, outcome, and suggestions for surgical management [J]. Neurosurgery, 1986, 18(6): 701-707.
[11] Jamin M, Lesoin F, Lozes G. Prognosis with 500 ruptured and operated intracranial arterial aneurysms[J]. Surg Neurol, 1984, 21(1): 13-18.
[12] 闫凯旋，高　恒，徐　伟，等. 前循环动脉瘤夹闭术中不 同破裂点对患者预后的影响[J]. 中国脑血管病杂志， 2014，11（11）：582-588.

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备注/Memo

备注/Memo:
基金项目：四川省卫生厅科研课题 （140106）
通讯作者：张施远，E-mail：thriller999@163.com
更新日期/Last Update: 2016-05-30