术中终板造瘘对动脉瘤性蛛网膜下腔出血后脑积水的疗效

摘要

目的 探究动脉瘤夹闭术中终板造瘘对动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)后脑积水的疗效.方法 回顾性分析146例aSAH后早期行开颅动脉瘤夹闭术病人的临床资料,根据术中是否施行终板造瘘分为动脉瘤夹闭术+终板造瘘组(终板造瘘组)80例及单纯动脉瘤夹闭术(单纯夹闭组)66例.比较两组脑积水的发生率以及疗效.结果 146例病人慢性脑积水的总发生率为20.5％(30/146),终板造瘘组和单纯夹闭组慢性脑积水的发生率分别为13.8％(11/80)、28.8％(19/66),单纯夹闭组慢性脑积水的发生率明显高于终板造瘘组(P<0.05).FisherⅢ和Ⅳ级病人中,单纯夹闭组慢性脑积水的发生率分别明显高于终板造瘘组(P<0.05);Hunt-HessⅢ和Ⅳ级病人中,单纯夹闭组慢性脑积水的发生率均明显高于终板造瘘组(P<0.05).终板造瘘组急性脑积水术后缓解率明显高于单纯夹闭组(P<0.05).结论 术中终板造瘘对aSAH后急性、慢性脑积水的疗效较好,尤其对Hunt-HessⅢ和Ⅳ级、FisherⅢ和Ⅳ级病人的疗效更好.%Objective To explore therapeutic efficacy of lamina terminalis fenestration during clipping for hydrocephalus after aneurysmal subarachnoid hemorrhage. Methods Clinical data of 146 patients with aneurysmal subarachnoid hemorrhage undergoing clipping in early stage were analyzed retrospectively. The patients were divided into fenestration group who received aneurysm clipping plus lamina terminalis fenestration ( n = 80 ) and clipping group who received single aneurysm clipping ( n = 66 ) . The differences in incidence and therapeutic efficacy of hydrocephalus between the two groups were analyzed. Results The overall incidence of chronic hydrocephalus of the patients was 20.5％(30/146). The incidence of chronic hydrocephalus was 13.8％(11/80) in fenestration group. The incidence of chronic hydrocephalus was 28.8％(19/66) in clipping group, which was higher than that in fenestration group (P<0.05). In the patients with FisherⅢandⅣ, incidences of chronic hydrocephalus were statistically higher in clipping group than in fenestration group respectively (P< 0.05). In the patients with Hunt-Hess grades Ⅲ and Ⅳ, incidences of chronic hydrocephalus were statistically higher in clipping group than in fenestration group respectively ( P < 0 . 05 ) . The postoperative remission rate of acute hydrocephalus was significantly higher in fenestration group than in clipping group ( P <0.05). Conclusions Lamina terminalis fenestration is good for acute and chronic hydrocephalus after aneurysmal subarachnoid hemorrhage, especially for patients with Hunt-Hess Ⅲ and Ⅳ grades and Fisher Ⅲ and Ⅳ grades