252例行开颅夹闭术的前交通动脉瘤患者回顾性分析

A Retrospective Analysis of 252 Patients with Anterior Communicating Artery Aneurysms Underwent Microsurgical Clipping

摘要: 目的：描述近些年前交通动脉瘤患者的基本临床特点，归纳总结各因素与预后的相关性，提高患者术后的生存质量。方法：回顾性分析青岛大学附属医院神经外科2018年1月至2021年12月连续治疗的一系列前交通动脉瘤患者的资料。经过单因素的秩和检验筛查，确定与预后的相关性危险因素，将相关性危险因素纳入二元Logistic回归，明确预后的独立危险因素。结果：在2018年至2021年期间，共有252名颅内前交通动脉瘤患者接受外科手术夹闭治疗(平均年龄57.8岁，SD = 9.8岁)。1) 患者中≤50岁的有63例，其中男性39名，女性24名(38%)；患者中>50岁的有189例，其中男性24名，女性103名(54%)，绝经后女性罹患动脉瘤的比率由38%升至54%，差异有统计学意义(P = 0.024)，发病年龄和动脉瘤大小无显著差异(P = 0.179)。2) 252例前交通动脉瘤患者术后3个月回访，治愈者(GOS 5)为227例(90%)，自理患者(GOS 4) 20例(8%)，植物生存患者(GO2-3) 4例(2%)，死亡1例。3) 经过秩和检验初筛，SAH的CT分型、Hunt-Hess分级、术后并发症是影响前交通动脉瘤患者手术预后的相关危险因素；年龄、性别、SAH次数、动脉瘤侧别、大小、指向、手术时机、手术入路与预后的差异无统计学意义。4) 二元Logistic回归分析，未获得有统计学意义的独立危险因素，可能与样本量小有关。结论：我们的研究结果表明：绝经后的女性罹患脑动脉瘤的风险大大增加，绝经后女性应提早筛查、预防SAH的发生。另外，SAH的CT分型、Hunt-Hess分级、术后并发症是影响前交通动脉瘤患者手术预后的相关危险因素。

Abstract: Objective: To describe the basic clinical characteristics of patients with communicating artery an-eurysms in recent years, summarize the correlation between various factors and prognosis, and improve the quality of life of patients after surgery. Methods: A data of consecutive series of patients with communicating artery aneurysms treated in the Affiliated Hospital of Qingdao University was retrospectively reviewed from January 2018 to December 2021. Univariate analysis was conducted to examine the associated risk factors that possibly affected the patients’ outcomes. Binary Logistic regression analysis was conducted to obtain the independent risk factors. Results: A total of 252 patients with intracranial anterior communicating artery aneurysms underwent microsurgical clipping (mean age 57.8 years, SD = 9.8 years) extending from 2018 to 2021. 1) There are 63 pa-tients who were less than 50-year-old, including of 39 males and 24 females (38%); And 189 pa-tients were older than 50 years old, including of 24 males and 103 females (54%). The incidence of aneurysms in postmenopausal women increased from 38% to 54%, and the difference was statisti-cally significant (P = 0.024). There was no significant difference between age and aneurysm size (P = 0.179). 2) A total of 252 patients with anterior communicating artery aneurysms were followed up 3 months after operation: 227 (90%) patients achieved a better outcome (GOS 5), 20 (8%) patients achieved a good outcome (GOS 4), 4 (2%) patients achieved a poor outcome (GO2-3) and one patient died. 3) Univariate analysis was conducted to prove the associated risk factors included character-istics of SAH on Computed Tomography (CT) scans, Hunt-Hess grade and absence of postoperative complications. There was no significant difference in age, sex, SAH times, aneurysm side, size, direc-tion, surgical timing, operation approach and prognosis. 4) Binary logistic regression analysis, in which no statistically significant independent risk factors were obtained, may be associated with small sample sizes. Conclusion: We concluded that postmenopausal women have a significantly in-creased risk of obtaining cerebral aneurysms, and the postmenopausal women should be screened early to prevent the occurrence of SAH. In addition, characteristics of SAH on Computed Tomogra-phy (CT) scans, Hunt-Hess grade and absence of postoperative complications are the risk factors af-fecting the prognosis of patients with anterior communicating artery aneurysms.