臺灣博碩士論文加值系統

背景: 我們針對2007年1月到2010年10月之間進行的手術案例，回顧性評估早期後交通動脈瘤(posterior communicating artery aneurysm)鉗夾術的結果。其中有44個手術案例是由翼點經側裂入路，34個手術案例是由顳前經海綿竇前床突入路。
方法: 我們將進行後交通動脈瘤鉗夾術的病患分成兩組，術後立即比較分析其結果。A組的42名病患進行的手術是由翼點經側裂入路，總共有44 個後交通動脈瘤 (24個已破裂，另外20個未破裂)。B組的32名病患進行的手術是由顳前經海綿竇前床突入路，總共有34 個後交通動脈瘤 (20個已破裂，另外14個未破裂)。
結果: A組的術後完全閉合率為97.7%，B組的術後完全閉合率為100%。針對已破裂的後交通動脈瘤病例，由顳前經海綿竇前床突入路進行鉗夾術，能顯著降低包含無症狀及有症狀的所有缺血性腦中風之發生風險(p = 0.04)。若考慮所有78個夾閉術案例，此法亦顯示能避免在手術時不慎造成動脈瘤破裂(p = 0.07)或降低所有缺血性腦中風(p = 0.06)的趨勢。雖然未達統計上意義，但由顳前經海綿竇前床突入路進行已破裂動脈瘤鉗夾術似乎也有趨勢能降低在手術時不慎造成動脈瘤再破裂的風險(p = 0.11)，而動脈瘤再破裂是造成有症狀缺血性腦中風的主因之一。本研究發現，若動脈瘤未破裂，由顳前經海綿竇前床突入路進行鉗夾術相較於傳統的由翼點經側裂入路並無額外的優點。
結論: 由顳前經海綿竇前床突入路進行手術，可清楚看見後交通動脈瘤周圍的主要神經血管結構，因此對降低手術時不慎造成動脈瘤破裂的風險，是一重大突破，而且使得在進行後交通動脈瘤鉗夾術後獲得非常滿意立即缺血性腦中風的結果，尤其是在動脈瘤已破裂的情況下更是如此。

Background: We retrospectively evaluated the adverse ischemic events as the early surgical results of microsurgical clipping of 44 and 34 posterior communicating artery (PComA) aneurysms through the pterional transsylvian and pretemporal transclinoidal approach, respectively, between January 2007 and October 2010.
Methods: The patients undergoing PComA aneurysm clipping were divided into two groups, and their immediate results were compared and analyzed. Those who underwent the pterional transsylvian approach, Group A, comprised 42 patients with 44 PComA aneurysms (24 ruptured and 20 unruptured). Those who underwent the pretemporal transclinoidal approach, Group B, comprised 32 patients with 34 PComA aneurysms (20 ruptured and 14 unruptured).
Results: The immediate postoperative total occlusion rates were 97.7% in Group A and 100% in Group B. The pretemporal transclinoidal approach significantly reduced the overall risk of silent and symptomatic ischemic strokes (p = 0.04) in ruptured PComA clippings and tended to lower the incidence of intraoperative aneurysm ruptures (p = 0.07) as well as the overall ischemic events (p = 0.06) in a total of 78 aneurysm clippings, as compared with the pterional transsylvian approach. Although not significantly, the pretemporal transclinoidal approach also tended to have lower incidence of intraoperative aneurysm ruptures in ruptured aneurysm clippings (p = 0.11) which were mainly responsible for the symptomatic ischemia. The pretemporal transclinoidal approach had no additional advantage over the traditional pterional transsylvian approach in unruptured PComA aneurysm clippings in the present study.
Conclusion: The pretemporal transclinoidal approach achieved better visualization of the vital neurovascular structures surrounding PComA aneurysms which might be a key improvement in lowering the risk of intraoperative aneurysm ruptures and obtaining significantly satisfactory immediate surgical results in the microsurgical clipping of PComA aneurysms, especially the ruptured ones.

目錄

論文電子檔著作權授權書……………………………………. i
論文審定同意書…………………………………………………… ii
誌謝………………………………………………………………………. iii
中文摘要………………………………………………………………. v
英文摘要………………………………………………………………. vii
圖目錄…………………………………………………………………... ix
表目錄…………………………………………………………………… x
正文………………………………………………………………………. xi
前言…………………………………………………………………. xi
方法…………………………………………………………………. xv
結果…………………………………………………………………. xvii
討論………………………………………………………………… xviii
結論………………………………………………………………… xxiii
參考文獻……………………………………………………………… xxiv

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