不同治疗方法对ACoAC动脉瘤治疗效果比较
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摘要
目的比较不同治疗方法对前交通动脉复合体(ACoAC)动脉瘤的效果。方法回顾分析我院2015年6月—2016年10月收治的120例破裂ACoAC动脉瘤病人临床资料,60例应用血管内个体化治疗(A组),其中采用单微导管栓塞法治疗25例(38.37%),双微导管栓塞法治疗18例,支架辅助法治疗10例,球囊辅助法治疗7例;60例采用传统开颅夹闭术治疗(B组)。比较A组不同方法治疗病人术后即刻完全栓塞率、术后6个月复发率及DSA复查距栓手术时间;比较A组和B组手术时间、术中出血量、住院时间、住院费用、术后1年改良Rankin评分及并发症发生情况。结果 A组不同栓塞术病人即刻完全栓塞率、复发率、DSA复查距栓手术时间比较差异均无显著性(P>0.05)。A组病人住院时间明显短于B组,住院费用、手术时间、术中出血量明显多于B组(t=4.334～26.105,P<0.05);两组病人术后并发症发生率均无明显差异(P>0.05)。术后随访6～12月,平均(7.9±1.1)月,A组改良Rankin评分与B组比较差异无显著性(P>0.05)。结论血管内介入动脉瘤栓塞术与传统开颅夹闭术对破裂ACoAC动脉瘤病人均具有良好治疗效果,其中前者适用于对手术耐受度较差、瘤体解剖位置较深的病人,后者适用于血管瘤解剖位置复杂的病人。
Objective To compare the efficacy of different treatment methods in the treatment of anterior communicating artery complex(ACoAC)aneurysms. Methods A retrospective study was performed on the clinical data of 120 patients with ruptured ACoAC aneurysms who were admitted to our hospital from June 2015 to October 2016.In these patients,sixty underwent personalized endovascular treatment(group A),including 25(38.37%)patients treated with single microcatheter embolization technique,18 patients treated with double microcatheter embolization technique,10 patients treated with stent-assisted therapy,and 7 patients treated with balloon-assisted therapy;another sixty patients underwent conventional craniotomy(group B).The complete embolization rate immediately after surgery,recurrence rate at 6 months after surgery,and time to digital subtraction angiography(DSA)reexamination were compared between patients treated with different methods in group A.The time of operation,intraoperative blood loss,length of hospital stay,hospital costs,postoperative 1-year modified Rankin score,and complications were compared between group A and group B. Results There were no significant differences in the complete embolization rate immediately after surgery,recurrence rate,or DSA reexamination time between patients treated with different embolization methods in group A(P>0.05).Group A had a significantly shorter hospital stay and significantly greater hospital costs,time of operation,and intraoperative blood loss than group B(t=4.334-26.105,P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P >0.05).The patients in the two groups were followed up for 6-12 months,with a mean follow-up time of 7.9±1.1 months.There was no significant difference in the modified Rankin score between the two groups(P>0.05). Conclusion Both endovascular embolization and conventional craniotomy achieve satisfactory treatment outcomes in patients with ruptured ACoAC aneurysms.Endovascular embolization is indicated for patients with poor surgical tolerance and deep-seated aneurysms,while conventional craniotomy is indicated for patients with complicated anatomical location of hemangiomas.
Objective To compare the efficacy of different treatment methods in the treatment of anterior communicating artery complex(ACoAC)aneurysms. Methods A retrospective study was performed on the clinical data of 120 patients with ruptured ACoAC aneurysms who were admitted to our hospital from June 2015 to October 2016.In these patients,sixty underwent personalized endovascular treatment(group A),including 25(38.37%)patients treated with single microcatheter embolization technique,18 patients treated with double microcatheter embolization technique,10 patients treated with stent-assisted therapy,and 7 patients treated with balloon-assisted therapy;another sixty patients underwent conventional craniotomy(group B).The complete embolization rate immediately after surgery,recurrence rate at 6 months after surgery,and time to digital subtraction angiography(DSA)reexamination were compared between patients treated with different methods in group A.The time of operation,intraoperative blood loss,length of hospital stay,hospital costs,postoperative 1-year modified Rankin score,and complications were compared between group A and group B. Results There were no significant differences in the complete embolization rate immediately after surgery,recurrence rate,or DSA reexamination time between patients treated with different embolization methods in group A(P>0.05).Group A had a significantly shorter hospital stay and significantly greater hospital costs,time of operation,and intraoperative blood loss than group B(t=4.334-26.105,P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P >0.05).The patients in the two groups were followed up for 6-12 months,with a mean follow-up time of 7.9±1.1 months.There was no significant difference in the modified Rankin score between the two groups(P>0.05). Conclusion Both endovascular embolization and conventional craniotomy achieve satisfactory treatment outcomes in patients with ruptured ACoAC aneurysms.Endovascular embolization is indicated for patients with poor surgical tolerance and deep-seated aneurysms,while conventional craniotomy is indicated for patients with complicated anatomical location of hemangiomas.
引文
[1]VAN BEEK S C,VAHL A,WISSELINK W,et al.Amsterdam acute aneurysm trial collaborators midterm re-interventions and survival after endovascular versus open repair for ruptured abdominal aortic aneurysm[J].European Journal of Vascular and Endovascular Surgery:the Official Journal of the European Society for Vascular Surgery,2015,49(6):661-668.
[2]林令超,王增亮,杜郭佳,等.大脑中动脉瘤破裂伴脑内血肿47例的显微手术治疗[J].中华显微外科杂志,2016,39(1):76-78.
[3]WANG J Y,SMITH R,YE X B,et al.Serial imaging surveillance for patients with a history of intracranial aneurysm:risk of De Novo aneurysm formation[J].Neurosurgery,2015,77(1):32-42.
[4]时雷.开颅夹闭与血管介入栓塞术治疗脑动脉瘤患者的临床观察[J].心脑血管病防治,2016,16(3):205-207.
[5]SONG J,PARK J E,KIM H R,et al.Observation of cerebral aneurysm wall thickness using intraoperative microscopy:clinical and morphological analysis of translucent aneurysm[J].Neurological Sciences,2015,36(6):907-912.
[6]巨清,于加省,陈如东,等.大脑后动脉动脉瘤的临床特征和血管内治疗(附17例报告)[J].中华神经外科杂志,2016,32(11):1143-1146.
[7]张建忠,刘信龙,徐正平,等.血管内治疗小脑后下动脉动脉瘤[J].中华神经外科杂志,2016,32(2):127-130.
[8]赵焱,陈向东,张艳梅,等.和肽素联合美国国立卫生研究院卒中评分和改良Rankin评分对急性脑梗死患者预后的预测价值[J].中国医师进修杂志,2016,39(8):681-685.
[9]李炳伟,于金录,张楠,等.重症前交通动脉瘤的手术夹闭治疗[J].中风与神经疾病杂志,2015,32(1):66-67.
[10]杨春利,聂洪杰,王樱,等.控制性降压技术在颅内血管瘤介入手术中的应用[J].河北医学,2017,23(1):163-165.
[11]梁爱军,张鸿祺,胡鹏.开颅手术治疗小脑后下动脉中段梭形动脉瘤一例[J].中国脑血管病杂志,2015,12(1):40-42.
[12]魏郢,唐从峰.介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤破裂的对比研究[J].神经损伤与功能重建,2016,11(1):69-71.
[13]谭华桥,李明华,朱悦琦,等.前交通动脉瘤破裂的临床和放射解剖学危险因素[J].介入放射学杂志,2016,25(7):562-567.
[14]张洪伟,孙勇,李爱民,等.眶外侧锁孔入路治疗低分级前交通动脉瘤[J].中国微创外科杂志,2016,16(4):347-350.
[15]高歌,余舰,张扬,等.破裂前交通动脉瘤的个体化介入栓塞治疗[J].中华神经医学杂志,2016,15(9):928-931.
[16]李俊君,路华.不同介入栓塞技术对前交通动脉瘤破裂患者认知功能的影响[J].介入放射学杂志,2016,25(5):374-376.
[17]何明方,刘宏,吴政俊,等.早期开颅动脉瘤夹闭治疗颅内破裂动脉瘤的临床研究[J].解放军医药杂志,2017,29(3):95-97.
[18]张睿,陈灿中.开颅夹闭与血管介入栓塞术治疗老年脑动脉瘤患者的临床效果观察[J].检验医学与临床,2017,14(Z1):299-300.
[19]郭海军,韩德清,陈玉光,等.显微开颅夹闭术与血管内栓塞对颅内前循环动脉瘤患者的疗效比较[J].神经损伤与功能重建,2016,11(1):66-68.
[20]宋炳伟,甄勇,何亮,等.显微夹闭手术时机对高分级动脉瘤性蛛网膜下腔出血患者预后的影响[J].中国脑血管病杂志,2015,12(7):352-355,379.
[21]傅军,李选,韩金涛,等.颅内动脉瘤介入治疗围术期处理的研究[J].中国微创外科杂志,2015,15(2):97-100.
[22]朱家球,陈震,陈慧珍,等.颅内前循环动脉瘤破裂后手术时机分析[J].实用医学杂志,2015,31(3):384-387.
[23]蒋世杰,张波,赵磊.外科手术与血管内治疗破裂颅内动脉瘤的疗效分析[J].重庆医学,2015,44(21):2921-2922,2925.
[24]胡新永,来海鸥,姬利,等.夹闭及栓塞治疗颅内动脉瘤对蛛网膜下腔出血患者脑血管痉挛及神经功能的影响[J].广西医科大学学报,2017,34(1):100-102.
[25]张玲玲,牟凌.动脉瘤性蛛网膜下腔出血患者介入术后认知功能调查和相关因素分析[J].介入放射学杂志,2015,24(8):730-732.
[26]呼铁民,杨立军,孟杰,等.显微手术夹闭及血管内介入栓塞术治疗高分级大脑中动脉瘤破裂的疗效及安全性研究[J].中国全科医学,2015,18(30):3671-3674.
[27]王东宝,周稳,曹培成,等.神经外科动脉瘤术后颅内感染危险因素logistic回归分析及防范措施[J].中华医院感染学杂志,2016,26(16):3749-3751.
[28]侯青,徐跃峤,程玮涛,等.支架辅助弹簧圈栓塞颅内动脉瘤围手术期严重神经系统并发症的分析[J].中国脑血管病杂志,2016,13(5):262-265.
[29]赵心同,李真保,方兴根,等.手术夹闭与血管内栓塞对大脑中动脉瘤治疗效果的分析[J].中国脑血管病杂志,2016,13(1):8-12.
[2]林令超,王增亮,杜郭佳,等.大脑中动脉瘤破裂伴脑内血肿47例的显微手术治疗[J].中华显微外科杂志,2016,39(1):76-78.
[3]WANG J Y,SMITH R,YE X B,et al.Serial imaging surveillance for patients with a history of intracranial aneurysm:risk of De Novo aneurysm formation[J].Neurosurgery,2015,77(1):32-42.
[4]时雷.开颅夹闭与血管介入栓塞术治疗脑动脉瘤患者的临床观察[J].心脑血管病防治,2016,16(3):205-207.
[5]SONG J,PARK J E,KIM H R,et al.Observation of cerebral aneurysm wall thickness using intraoperative microscopy:clinical and morphological analysis of translucent aneurysm[J].Neurological Sciences,2015,36(6):907-912.
[6]巨清,于加省,陈如东,等.大脑后动脉动脉瘤的临床特征和血管内治疗(附17例报告)[J].中华神经外科杂志,2016,32(11):1143-1146.
[7]张建忠,刘信龙,徐正平,等.血管内治疗小脑后下动脉动脉瘤[J].中华神经外科杂志,2016,32(2):127-130.
[8]赵焱,陈向东,张艳梅,等.和肽素联合美国国立卫生研究院卒中评分和改良Rankin评分对急性脑梗死患者预后的预测价值[J].中国医师进修杂志,2016,39(8):681-685.
[9]李炳伟,于金录,张楠,等.重症前交通动脉瘤的手术夹闭治疗[J].中风与神经疾病杂志,2015,32(1):66-67.
[10]杨春利,聂洪杰,王樱,等.控制性降压技术在颅内血管瘤介入手术中的应用[J].河北医学,2017,23(1):163-165.
[11]梁爱军,张鸿祺,胡鹏.开颅手术治疗小脑后下动脉中段梭形动脉瘤一例[J].中国脑血管病杂志,2015,12(1):40-42.
[12]魏郢,唐从峰.介入栓塞与开颅瘤颈夹闭术治疗颅内动脉瘤破裂的对比研究[J].神经损伤与功能重建,2016,11(1):69-71.
[13]谭华桥,李明华,朱悦琦,等.前交通动脉瘤破裂的临床和放射解剖学危险因素[J].介入放射学杂志,2016,25(7):562-567.
[14]张洪伟,孙勇,李爱民,等.眶外侧锁孔入路治疗低分级前交通动脉瘤[J].中国微创外科杂志,2016,16(4):347-350.
[15]高歌,余舰,张扬,等.破裂前交通动脉瘤的个体化介入栓塞治疗[J].中华神经医学杂志,2016,15(9):928-931.
[16]李俊君,路华.不同介入栓塞技术对前交通动脉瘤破裂患者认知功能的影响[J].介入放射学杂志,2016,25(5):374-376.
[17]何明方,刘宏,吴政俊,等.早期开颅动脉瘤夹闭治疗颅内破裂动脉瘤的临床研究[J].解放军医药杂志,2017,29(3):95-97.
[18]张睿,陈灿中.开颅夹闭与血管介入栓塞术治疗老年脑动脉瘤患者的临床效果观察[J].检验医学与临床,2017,14(Z1):299-300.
[19]郭海军,韩德清,陈玉光,等.显微开颅夹闭术与血管内栓塞对颅内前循环动脉瘤患者的疗效比较[J].神经损伤与功能重建,2016,11(1):66-68.
[20]宋炳伟,甄勇,何亮,等.显微夹闭手术时机对高分级动脉瘤性蛛网膜下腔出血患者预后的影响[J].中国脑血管病杂志,2015,12(7):352-355,379.
[21]傅军,李选,韩金涛,等.颅内动脉瘤介入治疗围术期处理的研究[J].中国微创外科杂志,2015,15(2):97-100.
[22]朱家球,陈震,陈慧珍,等.颅内前循环动脉瘤破裂后手术时机分析[J].实用医学杂志,2015,31(3):384-387.
[23]蒋世杰,张波,赵磊.外科手术与血管内治疗破裂颅内动脉瘤的疗效分析[J].重庆医学,2015,44(21):2921-2922,2925.
[24]胡新永,来海鸥,姬利,等.夹闭及栓塞治疗颅内动脉瘤对蛛网膜下腔出血患者脑血管痉挛及神经功能的影响[J].广西医科大学学报,2017,34(1):100-102.
[25]张玲玲,牟凌.动脉瘤性蛛网膜下腔出血患者介入术后认知功能调查和相关因素分析[J].介入放射学杂志,2015,24(8):730-732.
[26]呼铁民,杨立军,孟杰,等.显微手术夹闭及血管内介入栓塞术治疗高分级大脑中动脉瘤破裂的疗效及安全性研究[J].中国全科医学,2015,18(30):3671-3674.
[27]王东宝,周稳,曹培成,等.神经外科动脉瘤术后颅内感染危险因素logistic回归分析及防范措施[J].中华医院感染学杂志,2016,26(16):3749-3751.
[28]侯青,徐跃峤,程玮涛,等.支架辅助弹簧圈栓塞颅内动脉瘤围手术期严重神经系统并发症的分析[J].中国脑血管病杂志,2016,13(5):262-265.
[29]赵心同,李真保,方兴根,等.手术夹闭与血管内栓塞对大脑中动脉瘤治疗效果的分析[J].中国脑血管病杂志,2016,13(1):8-12.