直達手術未施行のクモ膜下出血患者110例の検討
破裂脳動脈瘤に対する直達手術未施行のクモ膜下出血症例110例を, 直達手術施行症例255例と比較し, 頻度, 性差, 入院時clinical grade, 神経放射線学的所見, 直達手術未施行の理由, 発症6ヵ月後のADL, 死因, 長期追跡調査について検討した.また直達手術未施行群を, 59歳以下, 60～69歳, 70歳以上の3群に分類し, 年齢による特徴をも検討した.非手術群の平均年齢は62.9歳で, 手術群の57.2歳より高く, 入院時clinical gradeIV, Vは前者で58%, 後者で15%と非手術群に重症例が多かった.非手術群では, computerized tomogr...
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| Published in | 脳卒中 Vol. 10; no. 4; pp. 319 - 325 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脳卒中学会
1988
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| Online Access | Get full text |
| ISSN | 0912-0726 1883-1923 |
| DOI | 10.3995/jstroke.10.319 |
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| Abstract | 破裂脳動脈瘤に対する直達手術未施行のクモ膜下出血症例110例を, 直達手術施行症例255例と比較し, 頻度, 性差, 入院時clinical grade, 神経放射線学的所見, 直達手術未施行の理由, 発症6ヵ月後のADL, 死因, 長期追跡調査について検討した.また直達手術未施行群を, 59歳以下, 60～69歳, 70歳以上の3群に分類し, 年齢による特徴をも検討した.非手術群の平均年齢は62.9歳で, 手術群の57.2歳より高く, 入院時clinical gradeIV, Vは前者で58%, 後者で15%と非手術群に重症例が多かった.非手術群では, computerized tomography上クモ膜下出血量が多く, 脳室内血腫の合併率も高かった.直達手術未施行の理由は, いずれの年齢層でもclinical grade不良が第1位で, 次いで再出血, 合併症などであった.非手術群の発症6カ月後の死亡率は77%と, 非常に予後不良であった.しかし, 出血源不明のために手術を施行しなかった症例は, 14例中13例が社会復帰しており, 予後良好であった. |
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| AbstractList | 破裂脳動脈瘤に対する直達手術未施行のクモ膜下出血症例110例を, 直達手術施行症例255例と比較し, 頻度, 性差, 入院時clinical grade, 神経放射線学的所見, 直達手術未施行の理由, 発症6ヵ月後のADL, 死因, 長期追跡調査について検討した.また直達手術未施行群を, 59歳以下, 60～69歳, 70歳以上の3群に分類し, 年齢による特徴をも検討した.非手術群の平均年齢は62.9歳で, 手術群の57.2歳より高く, 入院時clinical gradeIV, Vは前者で58%, 後者で15%と非手術群に重症例が多かった.非手術群では, computerized tomography上クモ膜下出血量が多く, 脳室内血腫の合併率も高かった.直達手術未施行の理由は, いずれの年齢層でもclinical grade不良が第1位で, 次いで再出血, 合併症などであった.非手術群の発症6カ月後の死亡率は77%と, 非常に予後不良であった.しかし, 出血源不明のために手術を施行しなかった症例は, 14例中13例が社会復帰しており, 予後良好であった. |
| Author | 川, 哲二 小笠原, 英敬 山本, 光生 上家, 和子 門田, 秀二 |
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| References | 4) Inagawa T, Ishikawa S, Aoki H, et al : Aneurysmal subarachnoid hemorrhage in Izumo city and Shimane prefecture of Japan. Part 1. Incidence. Stroke 19 : 170-175, 1988 15) Drake CG : The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26 : 96 -144, 1979 19) Hayward PD : Subarachnoid hemorrhage of unknown etiology. A clinical and radiological study of 51 cases. J Neurol Neurosurg Psychiatry 40 : 926-931, 1977 3) Jennett B, Bond M : Assessment of outcome after severe brain damage. A practical scale. Lancet 1 : 480-484, 1975 16) Inagawa T, Kamiya K, Ogasawara H, et al : Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28 : 93-99, 1987 2) 〓川啓二, 上家和子, 矢野 隆ら : 脳動脈瘤破裂患者におけるクモ膜下出血のCT分類と脳血管攣縮分類.島根医学7 : 320-325, 1985 8) Sacco RL, Wolf PA, Bharuhca NE, et al : Subarachnoid and intracerebral hemorrhage. Natural history, prognosis, and precursive factors in the Framingham study. Neurology 34 : 847-854, 1984 11) Nishimoto A, Ueta K, Onbe H, et al : Nationwide co-operative study of intracranial aneurysm surgery in Japan. Stroke 16 : 48-52, 1985 18) Sahs AL, Perret GE, Locksley HB, et al : Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Philadelphia, JB, Lippincott, 1969, pp109-124 20) 石井錬二, 黒木瑞雄, 田中隆一ら : 出血源不明のクモ膜下出血.Neurol Med Chir (Tokyo) 23-262-266, 1983 1) Hunt WE, Hess RM : Surgical risk as related to time to intervention in the repair of intracranial aneurysms. J Neurosurg 28 : 14-20, 1968 14) Ojemann RG, Heros RC : Spontaneous brain hemorrhage. Stroke 14 : 468-475, 1983 12) Little JR, Blomquist GA, Ethier R : Intraventricular hemorrhage in adults. Surg Neurol 8 : 143-149, 1977 5) Inagawa T, Takahashi M, Aoki H, et al : Aneurysmal subarachnoid hemorrhage in Izumo city and Shimane prefecture of Japan. Part 2. Overall outcome. Stroke 19 : 176-180, 1988 6) Drake CG : Management of cerebral aneurysm. Stroke 12 : 273-283, 1981 13) Mohr G, Ferguson G, Klan M, et al : Intraventricular hemorrhage from ruptured aneurysm. Retrospective analysis of 91 cases. J Neurosurg 58 : 482-487, 1983 10) Suzuki J, Hori S, Sakurai Y : Intracranial aneurysms in the neurosurgical clinics in Japan. J Neurosurg 35 : 34-39, 1971 7) Hata S, Dal SO, Ishii S : Cooperative study on ruptured aneurysm in Japanese neurosurgical clinics. Neurol Med Chir (Tokyo) 23 : 30-40, 1983 9) Suzuki J, Yoshimoto T : Distribution of cerebral aneurysms. In Pia HW, Langmaid C, Zierski J (eds) : Cerebral Aneurysms. Advances in Diagnosis and Therapy. Berlin, Springer-Verlag, 1979, pp127-133 17) 矢野 隆, 〓川哲二, 上家和子ら : 高齢者破裂脳動脈瘤患者の検討.脳卒中8 : 231-236, 1986 |
| References_xml | – reference: 19) Hayward PD : Subarachnoid hemorrhage of unknown etiology. A clinical and radiological study of 51 cases. J Neurol Neurosurg Psychiatry 40 : 926-931, 1977 – reference: 4) Inagawa T, Ishikawa S, Aoki H, et al : Aneurysmal subarachnoid hemorrhage in Izumo city and Shimane prefecture of Japan. Part 1. Incidence. Stroke 19 : 170-175, 1988 – reference: 12) Little JR, Blomquist GA, Ethier R : Intraventricular hemorrhage in adults. Surg Neurol 8 : 143-149, 1977 – reference: 2) 〓川啓二, 上家和子, 矢野 隆ら : 脳動脈瘤破裂患者におけるクモ膜下出血のCT分類と脳血管攣縮分類.島根医学7 : 320-325, 1985 – reference: 10) Suzuki J, Hori S, Sakurai Y : Intracranial aneurysms in the neurosurgical clinics in Japan. J Neurosurg 35 : 34-39, 1971 – reference: 11) Nishimoto A, Ueta K, Onbe H, et al : Nationwide co-operative study of intracranial aneurysm surgery in Japan. Stroke 16 : 48-52, 1985 – reference: 15) Drake CG : The treatment of aneurysms of the posterior circulation. Clin Neurosurg 26 : 96 -144, 1979 – reference: 5) Inagawa T, Takahashi M, Aoki H, et al : Aneurysmal subarachnoid hemorrhage in Izumo city and Shimane prefecture of Japan. Part 2. Overall outcome. Stroke 19 : 176-180, 1988 – reference: 3) Jennett B, Bond M : Assessment of outcome after severe brain damage. A practical scale. Lancet 1 : 480-484, 1975 – reference: 18) Sahs AL, Perret GE, Locksley HB, et al : Intracranial aneurysms and subarachnoid hemorrhage. A cooperative study. Philadelphia, JB, Lippincott, 1969, pp109-124 – reference: 14) Ojemann RG, Heros RC : Spontaneous brain hemorrhage. Stroke 14 : 468-475, 1983 – reference: 20) 石井錬二, 黒木瑞雄, 田中隆一ら : 出血源不明のクモ膜下出血.Neurol Med Chir (Tokyo) 23-262-266, 1983 – reference: 9) Suzuki J, Yoshimoto T : Distribution of cerebral aneurysms. In Pia HW, Langmaid C, Zierski J (eds) : Cerebral Aneurysms. Advances in Diagnosis and Therapy. Berlin, Springer-Verlag, 1979, pp127-133 – reference: 16) Inagawa T, Kamiya K, Ogasawara H, et al : Rebleeding of ruptured intracranial aneurysms in the acute stage. Surg Neurol 28 : 93-99, 1987 – reference: 6) Drake CG : Management of cerebral aneurysm. Stroke 12 : 273-283, 1981 – reference: 13) Mohr G, Ferguson G, Klan M, et al : Intraventricular hemorrhage from ruptured aneurysm. Retrospective analysis of 91 cases. J Neurosurg 58 : 482-487, 1983 – reference: 8) Sacco RL, Wolf PA, Bharuhca NE, et al : Subarachnoid and intracerebral hemorrhage. Natural history, prognosis, and precursive factors in the Framingham study. Neurology 34 : 847-854, 1984 – reference: 1) Hunt WE, Hess RM : Surgical risk as related to time to intervention in the repair of intracranial aneurysms. J Neurosurg 28 : 14-20, 1968 – reference: 17) 矢野 隆, 〓川哲二, 上家和子ら : 高齢者破裂脳動脈瘤患者の検討.脳卒中8 : 231-236, 1986 – reference: 7) Hata S, Dal SO, Ishii S : Cooperative study on ruptured aneurysm in Japanese neurosurgical clinics. Neurol Med Chir (Tokyo) 23 : 30-40, 1983 |
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| Snippet | 破裂脳動脈瘤に対する直達手術未施行のクモ膜下出血症例110例を, 直達手術施行症例255例と比較し, 頻度, 性差, 入院時clinical grade, 神経放射線学的所見, 直達手術未施行の理由, 発症6ヵ月後のADL, 死因, 長期追跡調査について検討した.また直達手術未施行群を, 59歳以下, 60～69歳,... |
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| Title | 直達手術未施行のクモ膜下出血患者110例の検討 |
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