摘要目的 探讨前交通动脉(AComA)动脉瘤最大瘤体高度与周边血管平均管径的比值(SR)与动脉瘤破裂的关系.方法 回顾性分析2010年10月至2014年12月温州医科大学附属第一医院神经外科收治的594例AComA动脉瘤患者的动脉瘤形态参数,其中破裂动脉瘤529例,未破裂动脉瘤65例.并分别收集动脉瘤最大瘤体高度、周边血管平均管径,同时分析两者的SR值与AComA动脉瘤破裂的关系.结果 594例AComA动脉瘤中,破裂动脉瘤的最大瘤体高度平均值为(4.26±2.19)mm,明显大于未破裂动脉瘤(2.82±2.04) mm,而破裂动脉瘤周边血管的平均管径为(1.91 ±0.54)mm,小于未破裂动脉瘤周边的血管平均管径(2.16 ±0.49) mm,两者比较差异均有统计学意义(均P＜0.001).破裂AComA动脉瘤中SR的平均值为2.52±2.15,而未破裂动脉瘤的SR平均值为1.38±1.09,两者比较差异有统计学意义(P ＜0.001).另外根据SR值的大小,将所有动脉瘤分为两组,其中SR值＞2组中动脉瘤的破裂率明显高于SR值≤2组(P＜0.001).AComA动脉瘤的SR值经ROC曲线分析后,其曲线下面积为0.744,最佳截断值为1.19.结论 SR值的大小与AComA动脉瘤破裂有明显的关系.临床上在决定AComA动脉瘤患者的治疗方案时,可考虑将SR值作为考参考因素.

abstractsObjective To investigate the relationship between the maximum height of anterior communicating artery (AComA) aneurysm or the size ratio (SR) of mean diameter of peripheral blood vessels and aneurysm rupture.Methods The morphological parameters of the aneurysms in 594 patients with AComA aneurysm admitted to the Department of Neurosurgery,the First Affiliated Hospital of Wenzhou Medical University from October 2010 to December 2014 were analyzed retrospectively.There were 529 patients with ruptured AcoA aneurysms and 65 with unruptured AComA aneurysms.The maximum height of aneurysms and the mean diameter of the peripheral vessels were collected respectively,and the relationship between SR and AComA aneurysm rupture in both of them were analyzed at the same time.Results Among the 594 patients with AComA aneurysm,the mean value of the maximum height of the aneurysms in the ruptured aneurysms was 4.26 ± 2.19 mm.It was obviously larger than 2.82 ± 2.04 mm of the unruptured aneurysms,and the mean diameter of the peripheral blood vessels of the ruptured aneurysms was 1.91 ±0.54 mm,it was smaller than the mean diameter of 2.16 ±0.49 mm in the peripheral blood vessels of the unruptured aneurysms.There was significant difference between both of them (all P ＜ 0.001).In the ruptured AComA aneurysms,the mean value of SR was 2.52 ±2.15,and that of the unruptured aneurysms was 1.38 ± 1.09.There was significant difference between both of them (P ＜ 0.001).In addition,all the aneurysms were divided into 2 groups according to the size of the SR values.The rupture rate of aneurysms in the SR ＞2 group was significantly higher than that in the SR ≤2 group (P ＜0.001).Mter the analysis of ROC curve,the area under the curve of the SR ≤2 value of AComA aneurysms was 0.744,and the optimal cut-off value was 1.19.Conclusions The size of SR value is significantly associated with the rupture of AComA aneurysms.When determining the treatment options for patients with AComA aneurysm in clinical practice,the SR value can be considered as a reference factor.