摘要
目的探讨无牵开器技术在经眉弓锁孔入路夹闭前循环动脉瘤手术的应用价值。方法回顾性分析51例经眉弓锁孔入路夹闭的前循环动脉瘤病例资料,其中无牵开器组27例,对照组24例。比较两组病人术中情况,术后7 d内CT和MRI明确的脑牵拉损伤表现,术后1个月日常生活能力量表(ADL)评分与改良Rankin评分(mRS)。结果在手术时间、术中失血量和术中动脉瘤破裂方面,无牵开器组与对照组比较,均无统计学差异(P>0.05),但两组脑牵拉损伤发生率存在明显差异(P=0.042)。术后1个月的ADL和mRS,无牵开器组均优于对照组(P=0.017,P=0.033)。结论在经眉弓锁孔入路夹闭前循环动脉瘤手术中,无牵开器技术可代替固定牵开器,不增加手术时间、术中失血量和动脉瘤破裂风险,并能减少脑牵拉损伤,有助于保护病人神经功能和改善术后生活质量。
Objective To investigate the clinical efficacy of retractorless surgery for anterior circulation aneurysms via transorbital keyhole approach. Methods The clinical data of 51 patients with anterior circulation aneurysm undergoing a minimally invasive surgery via the transorbital keyhole approach were analyzed retrospectively. The operation was performed using the retractorless technique（retractorless group） in 27 cases and fixed retractor in 24（control group）. The intraoperative conditions, brain retraction injury evaluated by postoperative CT and MRI within 7 days, and the results of Activities of Daily Living Scale（ADL） and modified Rankin Scale（m RS）1 month after the operation were compared between two groups. Results The operation time, intraoperative blood loss and aneurysm rupture showed no statistical difference between the two groups（ P〉0.05）. However, the incidence of brain retraction injury was significantly different between the two groups（P=0.042）. Compared with control group, The ADL and m RS of retractorless group was better those of the control 1 month after the operation（P=0.017, 0.033 respectively）. Conclusions The retractorless technique used in the operation via transorbital keyhole approach for anterior circulation aneurysm can replace the fixed retraction. Compared with the retractor surgery, retractorless surgery does not increase operation time, intraoperative blood loss and rate of aneurysm rupture, and is helpful in reducing brain retraction injury, protecting neurological function and improving patients＇ postoperative quality of life.
作者
张云龙
孙传顺
宋振声
顾建军
步星耀
Zhang Yunlong;Sun Chuanshun;Song Zhensheng;Gu Jianjun;Bu Xingyao(Department of Neurosurgery, Taikang People＇s Hospital, Zhoukou, He＇nan 461400;Department of Cerebrovascular Intervention;Department ofNeurosurgery, He＇nan Provincial People＇s Hospital, Zhengzhou, He＇nan 450003, China)
出处
《中国微侵袭神经外科杂志》
CAS
2017年第11期489-491,共3页
Chinese Journal of Minimally Invasive Neurosurgery
基金
河南省科技攻关重点项目(编号:0424410054)
关键词
颅内动脉瘤
前循环
无牵开器技术
入路
眉弓锁孔
intracranial aneurysm, anterior circulation
retractorless technique
approach, transorbital keyhole
