显微瘤颈夹闭术与血管内栓塞术治疗IA效果比较
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摘要
目的对比分析显微瘤颈夹闭术与血管内栓塞术对颅内动脉瘤(IA)的治疗效果。方法回顾性116例IA患者临床资料,根据其手术治疗方式差异分为显微瘤颈夹闭术组(夹闭组,n=70)与血管内栓塞术组(栓塞组,n=46)。观察两组手术情况(术中IA破裂率、IA闭塞率)、术后血管痉挛(CVS)和并发症发生情况;术后3个月,采用改良Rankin量表(mRs)评估患者预后情况。结果栓塞组术后CVS程度轻于夹闭组,术后并发症发生率小于夹闭组(P <0.05)。两组术中IA破裂率、IA闭塞率、预后良好率等比较均无统计学差异(P> 0.05)。结论显微瘤颈夹闭术与血管内栓塞术治疗IA的效果相当,均可获得良好预后,但血管内栓塞术所致CVS程度较轻、并发症发生率较低,具有一定优势。
Objective To compare and analyze the therapeutic effects of microaneurysm neck clipping and endovascular embolization on intracranial aneurysms(IA). Methods The clinical data of 116 patients with IA were retrospectively analyzed.According to the difference of operational methods, the patients were divided a clipping group(microaneurysm clipping, n=70) and an embolization group(endovascular embolization, n=46). The operation conditions(IA rupture rate and IA occlusion rate), postoperative vasospasm(CVS) and complications in the two groups were observed. The prognosis of patients was evaluated by means of modified Rankin scale(mRs) three months after the operation. Results The degree of CVS in embolization group was less than that in the clipping group, and the incidence of complications was less than that in the clipping group(P < 0.05). There was no significant difference in the IA rupture rate, IA occlusion rate and good prognosis between the two groups(P > 0.05). Conclusion The effect of microaneurysm neck clipping is similar to that of endovascular embolization in the treatment of IA, which can achieve good prognosis.However, endovascular embolization has some advantages, such as less CVS and lower incidence of complications.
Objective To compare and analyze the therapeutic effects of microaneurysm neck clipping and endovascular embolization on intracranial aneurysms(IA). Methods The clinical data of 116 patients with IA were retrospectively analyzed.According to the difference of operational methods, the patients were divided a clipping group(microaneurysm clipping, n=70) and an embolization group(endovascular embolization, n=46). The operation conditions(IA rupture rate and IA occlusion rate), postoperative vasospasm(CVS) and complications in the two groups were observed. The prognosis of patients was evaluated by means of modified Rankin scale(mRs) three months after the operation. Results The degree of CVS in embolization group was less than that in the clipping group, and the incidence of complications was less than that in the clipping group(P < 0.05). There was no significant difference in the IA rupture rate, IA occlusion rate and good prognosis between the two groups(P > 0.05). Conclusion The effect of microaneurysm neck clipping is similar to that of endovascular embolization in the treatment of IA, which can achieve good prognosis.However, endovascular embolization has some advantages, such as less CVS and lower incidence of complications.
引文
[1]袁晓东,吴勇.影响血管内介入治疗颅内动脉瘤预后的相关因素分析[J].成都医学院学报,2013,8(4):451-454.
[2]黄充,李志强.影响颅内动脉瘤性蛛网膜下腔出血预后的相关因素分析[J].中华老年医学杂志,2016,35(6):596-599.
[3]兰青,朱卿,许亮,等.对侧入路夹闭颅内动脉瘤的手术探讨[J].中华神经外科杂志,2016,32(2):112-116.
[4]Ahmed O,Storey C,Kalakoti P,et al.Treatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device[J].Interv Neuroradiol,2015,21(4):434-440.
[5]郭百海,周丽,彭德强.破裂的颅内动脉瘤大小联合Hunt-Hess分级对治疗和预后的评价[J].中国医师进修杂志,2012,35(11):41-43.
[6]王东海,吴红星,刘青林,等.Solitaire单支架辅助下颅内多发宽颈动脉瘤栓塞术[J].中华神经外科杂志,2015,31(6):548-551.
[7]沈建康.动脉瘤性蛛网膜下腔出血后脑血管痉挛的现代诊断和治疗[J].中国脑血管病杂志,2008,5(2):79-86.
[8]陶冶,薛维爽,滕伟禹.3种量表与自发性脑出血患者预后相关性的研究[J].中国医师杂志,2017,19(5):770-772.
[9]黄充,李志强.影响颅内动脉瘤性蛛网膜下腔出血预后的相关因素分析[J].中华老年医学杂志,2016,35(6):596-599.
[10]Nakagomi T,Furuya K,Tanaka J,et al.Clipping surgery for unruptured middle cerebral artery aneurysms[J].Acta Neurochir Suppl,2016,123(1):85-88.
[11]夏熙双,牛光明,张鹏远.显微外科手术在颅内动脉瘤治疗中的应用价值[J].中华老年医学杂志,2015,34(4):362-364.
[12]梁明礼,何海勇,秦峰,等.颅内动脉瘤破裂并颅内血肿形成的早期显微外科手术治疗[J].中华神经医学杂志,2015,14(6):572-575.
[13]Mascitelli JR,Moyle H,Oermann EK,et al.An update to the Raymond-Roy Occlusion Classification of intracranial aneurysms treated with coil embolization[J].J Neurointerv Surg,2015,7(7):496-502.
[14]吴照宇.蛛网膜下腔出血动脉瘤介入治疗的临床分析[J].成都医学院学报,2013,8(6):709-711.
[15]何国军,杜亚辉,李旭东.血管内介入栓塞治疗老年脑动脉瘤的手术效果及对Glasgow预后评分的影响[J].中国老年学杂志,2018,38(1):113-115.
[16]Fiorella D,Arthur A,Byrne J,et al.Interobserver variability in the assessment of aneurysm occlusion with the WEB aneurysm embolization system[J].J Neurointerv Surg,2015,7(8):591-595.
[2]黄充,李志强.影响颅内动脉瘤性蛛网膜下腔出血预后的相关因素分析[J].中华老年医学杂志,2016,35(6):596-599.
[3]兰青,朱卿,许亮,等.对侧入路夹闭颅内动脉瘤的手术探讨[J].中华神经外科杂志,2016,32(2):112-116.
[4]Ahmed O,Storey C,Kalakoti P,et al.Treatment of vertebrobasilar fusiform aneurysms with Pipeline embolization device[J].Interv Neuroradiol,2015,21(4):434-440.
[5]郭百海,周丽,彭德强.破裂的颅内动脉瘤大小联合Hunt-Hess分级对治疗和预后的评价[J].中国医师进修杂志,2012,35(11):41-43.
[6]王东海,吴红星,刘青林,等.Solitaire单支架辅助下颅内多发宽颈动脉瘤栓塞术[J].中华神经外科杂志,2015,31(6):548-551.
[7]沈建康.动脉瘤性蛛网膜下腔出血后脑血管痉挛的现代诊断和治疗[J].中国脑血管病杂志,2008,5(2):79-86.
[8]陶冶,薛维爽,滕伟禹.3种量表与自发性脑出血患者预后相关性的研究[J].中国医师杂志,2017,19(5):770-772.
[9]黄充,李志强.影响颅内动脉瘤性蛛网膜下腔出血预后的相关因素分析[J].中华老年医学杂志,2016,35(6):596-599.
[10]Nakagomi T,Furuya K,Tanaka J,et al.Clipping surgery for unruptured middle cerebral artery aneurysms[J].Acta Neurochir Suppl,2016,123(1):85-88.
[11]夏熙双,牛光明,张鹏远.显微外科手术在颅内动脉瘤治疗中的应用价值[J].中华老年医学杂志,2015,34(4):362-364.
[12]梁明礼,何海勇,秦峰,等.颅内动脉瘤破裂并颅内血肿形成的早期显微外科手术治疗[J].中华神经医学杂志,2015,14(6):572-575.
[13]Mascitelli JR,Moyle H,Oermann EK,et al.An update to the Raymond-Roy Occlusion Classification of intracranial aneurysms treated with coil embolization[J].J Neurointerv Surg,2015,7(7):496-502.
[14]吴照宇.蛛网膜下腔出血动脉瘤介入治疗的临床分析[J].成都医学院学报,2013,8(6):709-711.
[15]何国军,杜亚辉,李旭东.血管内介入栓塞治疗老年脑动脉瘤的手术效果及对Glasgow预后评分的影响[J].中国老年学杂志,2018,38(1):113-115.
[16]Fiorella D,Arthur A,Byrne J,et al.Interobserver variability in the assessment of aneurysm occlusion with the WEB aneurysm embolization system[J].J Neurointerv Surg,2015,7(8):591-595.