前循环动脉瘤患者动脉瘤破裂部位与预后的关系

摘要

Objective To analyze the relationship between tumor top,tumor neck,tumor rupture point of intraoperative aneurysm rupture (IAR) and the prognosis in patients with anterior circulation aneurysms (ACA) by craniotomy clipping.Methods Clinical materials of 123 patients with ACA (135 aneurysms) by craniotomy clipping were analyzed retrospectively,including 40 patients had IAR (41 aneurysms) during operation.The general informations of IAR patients were analyzed.Prognostic factors of IAR were analyzed by single and multiple factor analysis.Results The sex,age,history of hypertension,aneurysm diameter,the use of temporary blockage and blocking time,intraoperative blood loss showed no significant influences on the prognosis of patients with IAR (P ＞0.05),while preoperative Hunt-Hess classification and intraoperative rupture were the influencing factors for the prognosis of IAR patients (P ＜ 0.01).The preoperative Hunt-Hess classification and intraoperative rupture were the independent risk factors for the prognosis of IAR patients (P ＜0.01).Conclusion In craniotomy clipping,the different aneurysm rupture points can significantly affect the prognosis of patients with ACA,and aneurysm neck rupture is a main factor for poor prognosis of patients.%目的 探讨行开颅夹闭术治疗的前循环动脉瘤(ACA)患者动脉瘤破裂(IAR)的瘤顶、瘤颈、瘤体破裂点与预后的关系.方法 分析接受开颅夹闭术治疗的123例ACA患者(动脉瘤135个)的临床资料,术中40例患者(动脉瘤共41个)出现IAR现象.分析IAR患者的一般资料,进行单因素、多因素分析以探讨影响IAR者的预后因素.结果 IAR患者的性别、年龄、高血压史、动脉瘤直径、术中是否使用临时阻断夹以及阻断时间、术中失血量对预后无显著影响(P＞0.05),而术前Hunt-Hess分级、术中的破裂点对预后有显著影响(P＜0.01).术前Hunt-Hess分级、术中不同破裂点均是IAR患者预后的独立危险影响因子(P＜0.01).结论 ACA夹闭术中不同破裂点会显著影响IAR者的预后,且瘤颈部破裂是导致患者预后不良的重要因素.