显微夹闭手术治疗颈内动脉交通段破裂动脉瘤患者预后的影响因素OA

Objective To investigate the efficacy and prognostic factors of microsurgical clipping for ruptured aneurysms in the communicating segment of the internal carotid artery.Methods The clinical data of 108 patients with ruptured aneurysms in the communicating segment of the internal carotid artery who underwent microsurgical clipping at Harbin First Hospital from January 2022 to December 2024 were collected.The prognosis was assessed using the modified Rankin scale(mRS)6 months after surgery,and patients were divided into good prognosis group(n=81)and poor prognosis group(n=27).Clinical efficacy was analyzed by combining relevant clinical and follow-up data,and prognostic factors were analyzed using Logistic regression model.Results The complete clipping rates immediately and 6 months after surgery were 101(93.52%)cases and 104(96.30%)cases,respectively.The rebleeding rates were 2(1.85%)cases and 1(0.92%)case,respectively,and the vascular stenosis rates were 6(5.56%)cases and 4(3.70%)cases,respectively.Two(1.85%)cases of aneurysm recurrence occurred 6 months after surgery.Follow-up results showed that 81(75.00%)cases had good prognosis and 27(25.00%)cases had poor prognosis 6 months after surgery.There were significant differences in the timing of surgery,Hunt-Hess grade,white blood cell count,neutrophil-to-lymphocyte ratio(NLR),and D-dimer levels between the two groups(P<0.05).Logistic regression analysis showed that delayed timing of surgery,high Hunt-Hess grade,elevated NLR,and intraoperative aneurysm rupture were independent risk factors for poor prognosis after microsurgical clipping for internal carotid artery communicating segment ruptured aneurysms(P<0.05).Conclusion Microsurgical clipping has a good therapeutic effect on ruptured aneurysms in the communicating segment of internal carotid artery.Poor prognosis may be related to delayed timing of surgery,high Hunt-Hess grade,elevated NLR value,and intraoperative aneurysm rupture.