颅内动脉瘤血管内介入治疗的临床研究
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摘要
目的
探讨颅内动脉瘤血管内介入治疗的病例选择、手术时机和技术要点及其并发症的预防和处理,为颅内动脉瘤个性化介入治疗提供依据。
方法
回顾性分析2006年10月~2010年10月我院收治119例颅内动脉瘤患者临床资料,所有病人均经数字减影脑血管造影(DSA)检查确诊。观察发病年龄、既往相关病史、主要及伴随症状、Hunt-Hess分级进行术前整体状况评估等内容;DSA检查主要观察动脉瘤的解剖位置、大小、形态、数量;探讨血管内介入治疗的病例选择、手术方法、手术时机、疗效及并发症的干预措施。对以上内容进行Excel制表分析。
结果
血管内介入治疗119例病人,其中男51例、女68例,平均年龄51.7±17.1岁。动脉瘤性蛛网膜下腔出血发病高峰期处于40-59岁(69.7%)。共发现131个动脉瘤(其中2枚动脉瘤10例,3枚动脉瘤1例),多发动脉瘤占9.2%。颈内动脉系统113个(86.3%),椎基底动脉系统18个(13.7%)。按Hunt-Hess临床分级:0级7例、I级6例、II级89例、III级15例、Ⅳ级2例。本组病人单纯弹簧圈栓塞107例、Remodeling技术3例、支架辅助弹簧圈栓塞术9例、闭塞载瘤动脉9例、单纯支架植入术2例,1例椎动脉梭形动脉瘤自发血栓形成。其中3例术中动脉瘤出血,1例弹簧圈末端溢出;1例急性血栓形成。介入治疗时机以出血后3天内进行为佳。影像学随访到的47例病人中5例动脉瘤复发,1例动脉瘤再出血。
结论
血管内介入治疗为颅内动脉瘤患者治疗的有效方法之一,选择适当的手术时机及栓塞技术,会获得满意的临床效果,并发症少,死亡率低。预后与Hunt-Hess分级、是否存在基础疾病及急性期并发症相关。血管内治疗长期疗效有待于进一步随访,动脉瘤复发是随访的重要内容。
Objective
To study selecting cases of endovascular interventional treatment and estimated an opportune moment for intracranial aneurysm.We discussed the prevention and disposal of complication in process of interventional treatment.Then raised it in systemic and theoretic,it will be applied theory for supporting individuate interventional treatment of patiens with intracranial aneurysm in clinic.
Methods
The data of 119 patients with intracranial aneurysm were arranged from October 2006 to October 2010. All patients with intracranial aneurysm were confirmed by imageology and treated in our department.The clinical data included age of patients,previous history of patients,and chief or accompaniment symptom of patients,We used the modified Hunt and Hess grading scale to estimate the condition of hospital patients before operated.The imaging check reported the sites of aneurysm;the aneurysms’size,shape and quantity;to observe its various methods, the prevention and disposal of complication in process of interventional treatment.All the information of patients were tabled with Excel.
Results
In clinical data of 119 patients with intracranial aneurysm,male 51 cases,female 68 cases,the average age of male and female is 51.7±17.1 years old.There are 131 aneurysms in 119 patients,and 11 patients with more than two aneurysms.In 131 aneurysms,ICA are 113 cases(86.3%),BA-VA are 18 cases(13.7%); the result of Hunt and Hess grading scale is 0 grade 7cases, I grade 6 cases, II grade 89 cases, III grade 15 cases,Ⅳgrade 2 cases. In this group of patients,107 cases were embolized only by coils,9 cases were embolized by parent artery occlusion, 3 cases were embolized by technique of remodeling, 9 cases were embolized by stent and coils,2 cases were embolized by cover stent,1 VA-BA case was thrombosis. The opportune moment for intracranial aneurysm is within 3 days.3 patients had cerebral hemorrhage,1 case coil escaped during operation,1 case occurred severe cerebral thrombosis.In 47 patients who had follow-up by imaging,recanalization of aneurysm occurredin 5 cases(10.6%),one case hemorrhaged again.
Conclusion
Endovascular interventional treatment for patients with intracranial aneurysms is an effective method.We will acquire a satisfying clinical result by selecting an opportune moment and embolism technic. Prognosis are closely associated with Hunt and Hess grading scale,basic illness and complication in acute stage. Clinical follow-up have important significance for treatment of patients with intracranial aneurysm.Recurrence of aneurysm is major substance in follow-up.
探讨颅内动脉瘤血管内介入治疗的病例选择、手术时机和技术要点及其并发症的预防和处理,为颅内动脉瘤个性化介入治疗提供依据。
方法
回顾性分析2006年10月~2010年10月我院收治119例颅内动脉瘤患者临床资料,所有病人均经数字减影脑血管造影(DSA)检查确诊。观察发病年龄、既往相关病史、主要及伴随症状、Hunt-Hess分级进行术前整体状况评估等内容;DSA检查主要观察动脉瘤的解剖位置、大小、形态、数量;探讨血管内介入治疗的病例选择、手术方法、手术时机、疗效及并发症的干预措施。对以上内容进行Excel制表分析。
结果
血管内介入治疗119例病人,其中男51例、女68例,平均年龄51.7±17.1岁。动脉瘤性蛛网膜下腔出血发病高峰期处于40-59岁(69.7%)。共发现131个动脉瘤(其中2枚动脉瘤10例,3枚动脉瘤1例),多发动脉瘤占9.2%。颈内动脉系统113个(86.3%),椎基底动脉系统18个(13.7%)。按Hunt-Hess临床分级:0级7例、I级6例、II级89例、III级15例、Ⅳ级2例。本组病人单纯弹簧圈栓塞107例、Remodeling技术3例、支架辅助弹簧圈栓塞术9例、闭塞载瘤动脉9例、单纯支架植入术2例,1例椎动脉梭形动脉瘤自发血栓形成。其中3例术中动脉瘤出血,1例弹簧圈末端溢出;1例急性血栓形成。介入治疗时机以出血后3天内进行为佳。影像学随访到的47例病人中5例动脉瘤复发,1例动脉瘤再出血。
结论
血管内介入治疗为颅内动脉瘤患者治疗的有效方法之一,选择适当的手术时机及栓塞技术,会获得满意的临床效果,并发症少,死亡率低。预后与Hunt-Hess分级、是否存在基础疾病及急性期并发症相关。血管内治疗长期疗效有待于进一步随访,动脉瘤复发是随访的重要内容。
Objective
To study selecting cases of endovascular interventional treatment and estimated an opportune moment for intracranial aneurysm.We discussed the prevention and disposal of complication in process of interventional treatment.Then raised it in systemic and theoretic,it will be applied theory for supporting individuate interventional treatment of patiens with intracranial aneurysm in clinic.
Methods
The data of 119 patients with intracranial aneurysm were arranged from October 2006 to October 2010. All patients with intracranial aneurysm were confirmed by imageology and treated in our department.The clinical data included age of patients,previous history of patients,and chief or accompaniment symptom of patients,We used the modified Hunt and Hess grading scale to estimate the condition of hospital patients before operated.The imaging check reported the sites of aneurysm;the aneurysms’size,shape and quantity;to observe its various methods, the prevention and disposal of complication in process of interventional treatment.All the information of patients were tabled with Excel.
Results
In clinical data of 119 patients with intracranial aneurysm,male 51 cases,female 68 cases,the average age of male and female is 51.7±17.1 years old.There are 131 aneurysms in 119 patients,and 11 patients with more than two aneurysms.In 131 aneurysms,ICA are 113 cases(86.3%),BA-VA are 18 cases(13.7%); the result of Hunt and Hess grading scale is 0 grade 7cases, I grade 6 cases, II grade 89 cases, III grade 15 cases,Ⅳgrade 2 cases. In this group of patients,107 cases were embolized only by coils,9 cases were embolized by parent artery occlusion, 3 cases were embolized by technique of remodeling, 9 cases were embolized by stent and coils,2 cases were embolized by cover stent,1 VA-BA case was thrombosis. The opportune moment for intracranial aneurysm is within 3 days.3 patients had cerebral hemorrhage,1 case coil escaped during operation,1 case occurred severe cerebral thrombosis.In 47 patients who had follow-up by imaging,recanalization of aneurysm occurredin 5 cases(10.6%),one case hemorrhaged again.
Conclusion
Endovascular interventional treatment for patients with intracranial aneurysms is an effective method.We will acquire a satisfying clinical result by selecting an opportune moment and embolism technic. Prognosis are closely associated with Hunt and Hess grading scale,basic illness and complication in acute stage. Clinical follow-up have important significance for treatment of patients with intracranial aneurysm.Recurrence of aneurysm is major substance in follow-up.
引文
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[3] Mayberg MR,Batjer HH,aceyR,et al.Guidelines for the management of aneurysmal subarachnoid haemorrhage.A statement for health care professionals from a special writing group of the Stroke Council.American Heart Association.Stroke, 1994, 25: 2315-2328.
[4]马廉亭主编.介入神经外科学.第1版.武汉:湖北科学技术出版社,2003: 325~344.
[5] Findlay JM.A randomized trial of intraoperative,intracisternal tissue plasminogen activator for the prevention of vasospasm[J].Neurosurgery,1995,37(5):1026-1027.
[6] Alshekhlee A,Mehta S,Edgell RC,etal,Hospital mortality and complications of electively clipped or coiled unruptured intracrani-al aneurysm[J].Stroke,2010, 41(7):1471-1476.
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