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目的对1990年1月至2004年12月治疗的157例前交通动脉瘤患者作一回顾性分析。方法所有病例均在全麻下施行手术,经翼点入路手术152例,经前纵裂入路手术5例。其中施行瘤颈夹闭术者154例,另3例因动脉瘤较小或为前交通动脉的梭形扩张者施行动脉瘤包裹术。对26例IV、V级的动脉瘤手术中清除局部血肿后,对其中14例脑压较高者或术后因脑水肿反应严重者在首次手术时或再次手术行去骨瓣或颞肌下减压术。结果根据格拉斯哥预后分级(G lasgow ou tcom e score,GO S)判断,本组手术后近期恢复良好者140例(89.2%),中残5例(3.2%),重残4例(2.5%),死亡8例(5.1%,包括因病情危重家属放弃治疗的患者)。死亡的8例中有7例为IV、V级的患者,另1例为动脉瘤包裹术后因再出血死亡。严重残废的4例患者也均为IV、V级病例。结论对出血时间在数小时之内、具有典型前交通动脉瘤的CT表现、病情十分危重的患者,可直接进行手术探察;对出血后早期呈IV、V级状态的患者,积极手术可能挽救一部分患者的生命。
Objective To retrospectively analyze 157 cases of anterior communicating aneurysms treated from January 1990 to December 2004. Methods All cases underwent surgery under general anesthesia. There were 152 cases with pterional approach and 5 cases with anterior longitudinal splitting. Among them, 154 patients underwent neck clipping, and the other 3 patients underwent aneurysm wrapping due to the smaller aneurysm or spindle expansion of the anterior communicating artery. 26 cases of IV, V grade aneurysm surgery in the removal of local hematoma, of which 14 cases of high intracranial pressure or postoperative brain response due to severe brain edema in the first operation or re-operation of the crab flap or temporal muscle hypothyroidism Pressure surgery. Results According to the Glasgow ou tcom e score (GO S), 140 patients (89.2%), moderate disability (3.2%) and severe disability (2.5%) were recovered well in this group. , And 8 deaths (5.1%, including those who gave up their treatment due to their critically ill relatives). Of the 8 deaths, 7 were IV and V-grade patients and the other 1 died of rebleeding after the aneurysm wrapping procedure. 4 patients with severe disability are also IV, V grade cases. Conclusions For patients presenting with typical anterior communicating artery aneurysm within a few hours with typical anterior communicating artery aneurysm, the patient may be directly explored by surgery. In patients with IV or V status after early bleeding, aggressive surgery may save some Patient’s life.