摘要
目的探讨眶上外侧入路与翼点入路夹闭前循环动脉瘤的临床疗效以及对围术期指标和预后的影响。方法选择2015年1月—2019年10月收治的前循环动脉瘤患者74例,根据手术入路不同进行分组,眶上外侧入路者39例为观察组,翼点入路者35例为对照组。比较2组术中动脉瘤破裂及术后3个月动脉瘤残留情况,围术期指标、并发症发生率、格拉斯哥预后评分(GOS)情况,观察手术前后血清神经元特异性烯醇化酶(NSE)和S100β蛋白水平变化。结果2组术中动脉瘤破裂率、术后3个月动脉瘤残留率比较差异均无统计学意义(P>0.05)。观察组切口长度短于对照组,骨窗面积、骨质缺损面积小于对照组,术中出血量少于对照组,手术时间、住院时间短于对照组(P<0.05)。术后1 d,2组血清NSE和S100β水平均较术前升高,但观察组低于对照组(P<0.05)。观察组并发症发生率低于对照组,GOS评分优良率高于对照组(P<0.05)。结论与翼点入路夹闭前循环动脉瘤比较,眶上外侧入路可明显缩短手术时间和住院时间,减少手术损伤和术后并发症,有较好的预后。
Objective To investigate the clinical effect of supraorbital lateral approach and pterional approach in clipping anterior circulation aneurysms and their influence on perioperative indexes and prognosis.Methods A total of 74 patients with anterior circulation aneurysms treated from January 2015 to October 2019 were selected and grouped according to different surgical approaches.39 cases of supraorbital lateral approach were included as observation group and 35 cases of pterional approach were included as control group.Intraoperative aneurysm rupture and residual aneurysm at 3 months after operation,perioperative indicators,incidence of complications,Glasgow outcome score(GOS)were compared between the two groups.The changes of serum neuronal specific enolase(NSE)and S100βprotein levels before and after surgery were observed.Results There were no significant differences in the intraoperative aneurysm rupture rate and postoperative aneurysm residual rate at 3 months after operation between the two groups(P>0.05).The incision length in observation group was shorter than that in control group,and the area of bone window and bone defect were smaller than those in control group.In addition,the intraoperative blood loss was less than that in control group,and the duration of operation and length of hospital stay were shorter than those in control group(P<0.05).At 1d after surgery,the serum NSE and S100βlevels in the two groups were increased compared with those before surgery,but in observation group were lower than those in control group(P<0.05).The incidence rate of complications in observation group was lower than that in control group,while the excellent and good rate of GOS score was higher than that in control group(P<0.05).Conclusion Compared with pterional approach in clipping anterior circulation aneurysms,supraorbital lateral approach can significantly shorten the duration of operation and length of hospital stay,and reduce the occurrence of surgical injuries and postoperative complications,with better progno
作者
黄文跃
顾斌
高金华
王勉
潘捷
HUANG Wen-yue;GU Bin;GAO Jin-hua;WANG Mian;PAN Jie(Department of Neurosurgery,the First People's Hospital of Anqing,Anqing,Anhui 246002,China;Department of Neurosurgery,Zhongda Hospital Affiliated to Southeast University of Nanjing,Nanjing 210009,China)
出处
《解放军医药杂志》
CAS
2020年第6期91-94,共4页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
基金
江苏省卫生计生委项目(H2017032)。
关键词
前循环动脉瘤
眶上外侧入路
翼点入路
围手术期
并发症
格拉斯哥预后评分
Anterior circulation aneurysm
Lateral supraorbital approach
Pterional approach
Perioperative period
Complications
Glasgow outcome scale
