后交通动脉瘤夹闭术后并发同侧内囊后肢梗塞的相关因素分析
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摘要
目的探讨后交通动脉瘤夹闭术后并发同侧内囊后肢梗塞的相关因素。方法回顾性分析徐州医科大学附属医院神经外科2014年11月至2017年12月行夹闭手术治疗的189例后交通动脉瘤患者的临床资料,共计手术193例次(4例患者行双侧手术)。按照患者术后复查头颅CT中是否出现同侧内囊后肢梗塞分为2组,非梗塞组166例次,梗塞组27例次。观察2组患者Hunt-Hess分级、Fisher分级、动脉瘤大小、是否放置多个动脉瘤夹、术中动脉瘤是否破裂、出血后手术时机、年龄、高血压病史的差异。结果 193例后交通动脉瘤夹闭术后有27例患者发生同侧内囊后肢梗塞,发生率为14. 0%。单因素分析结果显示,2组患者Hunt-Hess分级、Fisher分级、术中动脉瘤是否破裂比较差异有统计学意义(P <0. 05),二元logistic回归分析提示术中动脉瘤是否破裂在两组间差异有统计学意义(P <0. 05)。结论后交通动脉瘤夹闭术中动脉瘤是否破裂是造成患者术后并发同侧内囊后肢梗塞的独立危险因素。术中减少动脉瘤破裂,则能减少患者术后并发同侧内囊后肢梗塞的风险。
Objective To investigate the relevant factors of ipsilateral posterior capsular infarction after posterior communicating artery aneurysm clipping. Methods The clinical data of 189 postoperative patients with posterior communicating artery aneurysm treated in the neurosurgery department of Xuzhou medical university from November 2014 to December 2017 were retrospectively analyzed,a total of 193 surgeries were performed( 4 patients underwent bilateral surgery). The patients were divided into two groups according to whether there was ipsilateral posterior capsular infarction in cranial CT after reexamination,of whom 166 cases were in the non-infarct group and 27 cases were in the infarct group. The differences of Hunt-Hess grade,Fisher grade,aneurysm size,multiple aneurysm clips placement,intraoperative aneurysm rupture,timing of operation after bleeding,age,and history of hypertension between the two groups were observed. Results Among 193 cases of posterior communicating artery aneurysm clipping,there were 27 cases with ipsilateral posterior capsular infarction,the incidence was14. 0%. Univariate analysis revealed that there were statistically significant differences between the two groups in terms of Hunt-Hess grade,Fisher grade and intraoperative aneurysm rupture( P < 0. 05). Binary logistic regression analysis suggested that there was a statistical difference between the two groups in whether the aneurysm ruptures during surgery( P < 0. 05). Conclusion Rupture of the aneurysm or not during posterior communicating artery aneurysm clipping is an independent risk factor for postoperative ipsilateral posterior capsular infarction.Reducing aneurysm rupture during operation can reduce the risk of ipsilateral posterior capsular infarction.
Objective To investigate the relevant factors of ipsilateral posterior capsular infarction after posterior communicating artery aneurysm clipping. Methods The clinical data of 189 postoperative patients with posterior communicating artery aneurysm treated in the neurosurgery department of Xuzhou medical university from November 2014 to December 2017 were retrospectively analyzed,a total of 193 surgeries were performed( 4 patients underwent bilateral surgery). The patients were divided into two groups according to whether there was ipsilateral posterior capsular infarction in cranial CT after reexamination,of whom 166 cases were in the non-infarct group and 27 cases were in the infarct group. The differences of Hunt-Hess grade,Fisher grade,aneurysm size,multiple aneurysm clips placement,intraoperative aneurysm rupture,timing of operation after bleeding,age,and history of hypertension between the two groups were observed. Results Among 193 cases of posterior communicating artery aneurysm clipping,there were 27 cases with ipsilateral posterior capsular infarction,the incidence was14. 0%. Univariate analysis revealed that there were statistically significant differences between the two groups in terms of Hunt-Hess grade,Fisher grade and intraoperative aneurysm rupture( P < 0. 05). Binary logistic regression analysis suggested that there was a statistical difference between the two groups in whether the aneurysm ruptures during surgery( P < 0. 05). Conclusion Rupture of the aneurysm or not during posterior communicating artery aneurysm clipping is an independent risk factor for postoperative ipsilateral posterior capsular infarction.Reducing aneurysm rupture during operation can reduce the risk of ipsilateral posterior capsular infarction.
引文
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[19]王立君,林成海,邵正凯,等.颅内动脉瘤术中破裂的危险因素分析[J].中国脑血管病杂志,2006,3(8):369-372. doi:10. 3969/j.issn. 1672-5921. 2006. 08. 010.
[20]吴京雷,罗明,张严国,等.前循环动脉瘤夹闭术中破裂的原因、预防及处理[J].中国临床神经外科杂志,2013,18(7):425-427.
[21]Ota N,Tanikawa R,Miyazaki T,et al. Surgical microanatomy of the anterior clinoid process for paraclinoid aneurysm surgery and efficient modification of extradural anterior clinoidectomy[J]. World Neurosurg,2015,83(4):635-643. doi:10. 1016/j. wneu. 2014. 12. 014.
[22]Sandalcioglu IE,Sehooch B,Regel JP,et al. Does intraoperative aneurysm rupture influence outcome:analysis of 169 patients[J]. Clin Neurosurg,2004,106(2):88-92.
[23]Leipzig TJ,Morgan J,Horner TG,et al. Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms[J]. Neurosurgery,2005,56(3):455-468.
[24]Hsu CE,Lin TK,Lee MH,et al. The impact of surgical experience on major intraoperative aneurysm rupture and their consequences on outcome:a multivariate analysis of 538 microsurgical clipping cases[J].PLo S One,2016,11(3):e0151805. doi:10. 1371/journal. pone.0151805.
[2]Golshani K,Ferrell A,Zomorodi A,et al. A review of the management of posterior communicating artery aneurysms in the modern era[J]. Surg Neurol Int,2010,1:88. doi:10. 4103/2152-7806. 74147.
[3]Konakondla S,Griessenauer CJ,Fong RP,et al. zero-delay mechanical thrombectomy for distal large vessel occlusion detected on intraoperative angiogram after microsurgical clipping of a posterior communicating artery aneurysm:value of hybrid operating room[J]. World Neurosurg,2018,119:278-281. doi:10. 1016/j. wneu. 2018. 08. 088.
[4]王玉社,王勇,陈航,等.蛛网膜下腔出血患者Hunt-Hess分级与血清脑钠肽的关系[J].中华实验神经外科杂志,2016,33(9):2199-2131. doi:10. 3760/cma. j. issn. 1001-9030. 2016. 09. 020.
[5]雷勇前.血管内栓塞术和夹闭术治疗动脉瘤性蛛网膜下腔出血临床研究[J].医学临床研究,2016,33(2):340-342.
[6]Takeda M,Kashimura H,Chida K,et al. Microsurgical clipping for the true posterior communicating artery aneurysm in the distal portion of the posterior communicating artery[J]. Surg Neurol Int,2015,6:101. doi:10. 4103/2152-7806. 158515.
[7]Javanovic IB,Milo jevic Tm,Djurovic BM,et al. Results of the operative treatment of the ruptured aneurysm:prospective clinical study[J]. Acta Chir lugosl,2008,55(2):79-91.
[8]刘旭超,孙文博,韩振民,等.不同级别颅内动脉瘤患者手术时机的探讨[J].中华神经外科杂志,2017,33(10):1047-1049. doi:10.3760/cma. j. issn. 1001-2346. 2017. 10. 021.
[9]Pandey AS,Koebbe C,Rosenwasser RH,et al. Endovascular coil embolization of ruptured and unruptured posterior circulation aneurysms:review of a 10-year experience[J]. Neurosurgery,2007,60(4):626-636.
[10]赵继宗,李京生,王硕,等.颅内动脉瘤1041例显微手术治疗临床研究[J].中华医学杂志,2003,83(1):6-8. doi:10. 3760/j:issn:0376-2491. 2003. 01. 003.
[11]Brilstra EH,Algra A,Rinkel GJ,et al. Effectiveness of neurosurgical clip application in patients with aneurismal subarachnoid hemorrhage[J]. J Neurosurg,2002,97(5):1036-1041.
[12]陈志,冯华,王宪荣,等.影响颅内动脉瘤破裂手术预后的多因素分析[J].中国神经精神疾病杂志,2001,27(1):52. doi:10.3969/j. issn. 1002-0152. 2001. 01. 022.
[13]黄国栋,李维平,高永中,等.显微手术治疗颅内动脉瘤后脑血管痉挛的相关因素分析[J].中国现代医学杂志,2012,22(34):58-61. doi:10. 3760/cma. j. issn. 1671-8925. 2011. 07. 014.
[14]王明,蒋宇钢.颅内破裂动脉瘤夹闭术后脑缺血损伤的综合防治[J].神经疾病与精神卫生,2017,17(10):735-738. doi:10.3969/j. issn. 1009-6574. 2017. 10. 013.
[15]Stein SC,Browne KD,Chen XH,et al. Thromboembolism and delayed cerebral ischemia after subarachnoid hemorrhage:an autopsy study[J]. Neurosurgery,2006,59(4):781-787.
[16]Kassell NF,Torner JC,Jane JA,et al. International cooperative study on the time of aneurysm surgery. PartⅡ,surgical result[J]. J Neurosurgery,1990,73(1):37.
[17]Hoh BL,Curry WT Jr,Carter BS,et al. Computed tomographic demonstrated infarcts after surgical and endovascular treatment of aneurysmal subarachnoid hemorrhage[J]. Acta Neurochirurgica,2004,146(11):1177-1183. doi:10. 1007/s00701-004-0349-6.
[18]只达石.脑动脉瘤破裂伴灶性积血的临床意义[J].中华神经外科,1995,11(1):6-8.
[19]王立君,林成海,邵正凯,等.颅内动脉瘤术中破裂的危险因素分析[J].中国脑血管病杂志,2006,3(8):369-372. doi:10. 3969/j.issn. 1672-5921. 2006. 08. 010.
[20]吴京雷,罗明,张严国,等.前循环动脉瘤夹闭术中破裂的原因、预防及处理[J].中国临床神经外科杂志,2013,18(7):425-427.
[21]Ota N,Tanikawa R,Miyazaki T,et al. Surgical microanatomy of the anterior clinoid process for paraclinoid aneurysm surgery and efficient modification of extradural anterior clinoidectomy[J]. World Neurosurg,2015,83(4):635-643. doi:10. 1016/j. wneu. 2014. 12. 014.
[22]Sandalcioglu IE,Sehooch B,Regel JP,et al. Does intraoperative aneurysm rupture influence outcome:analysis of 169 patients[J]. Clin Neurosurg,2004,106(2):88-92.
[23]Leipzig TJ,Morgan J,Horner TG,et al. Analysis of intraoperative rupture in the surgical treatment of 1694 saccular aneurysms[J]. Neurosurgery,2005,56(3):455-468.
[24]Hsu CE,Lin TK,Lee MH,et al. The impact of surgical experience on major intraoperative aneurysm rupture and their consequences on outcome:a multivariate analysis of 538 microsurgical clipping cases[J].PLo S One,2016,11(3):e0151805. doi:10. 1371/journal. pone.0151805.