108例颅内动脉瘤血管内介入栓塞临床分析
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摘要
目的
探讨血管内介入栓塞治疗颅内动脉瘤的疗效,总结临床经验并指导实践。
方法
采用MDS或GDC对108例颅内动脉瘤患者进行血管内介入栓塞治疗,观察近期、远期疗效,并进行疗效分析。
结果
完全栓塞98例(90.74%),不完全栓塞7例(6.48%),部分栓塞2例(1.85%),失败1例(0.93%)。发生并发症4例(3.70%)。术后3个月mRS评价,预后良好98例(90.74%),中度残疾5例(4.63%),重度残疾1例(0.93%),死亡4例(3.70%)。随访3-36个月,部分栓塞1例复发,再行GDC栓塞成功,其余未见复发,动脉瘤不复显影。血管内介入栓塞疗效随介入时机延迟和Hunt-Hess分级升高呈下降趋势,MDS与GDC栓塞无显著性差异。
结论
血管内介入栓塞是一种安全、可靠、有效的颅内动脉瘤治疗方法。
Objective
To investigate the efficacy of the intravascular interventional embolization on intracranial aneurysms, summarize the clinical experience and guide practice.
Methods
The MDS or GDC were used on108cases of patients with intravascular aneurysms to take intracranial interventional embolization, the recently, the long-term efficacy were observed, and analyzed the efficacy.
Results
98cases of complete embolization (90.74%),7cases of incomplete embolization (6.48%),2cases of partial embolization (1.85%), one cases was failure (0.93%). Complications occurred on4cases (3.70%). After3months took mRS evaluation,98cases had good prognosis (90.74%),5cases were moderate disability (4.63%),1cases was severe disability (0.93%),4patients died (3.70%). The patients were followed up for3to38months,1patients with partial embolization was recurrent, and with success by re-GDC embolization, the rest had no recurrence, the aneurysm was no longer developing. The efficacy of endovascular embolization showed a downward trend with intervention time delay and Hunt-Hess grade increases, the MDS and GDC embolization had no significant difference.
Conclusion
Endovascular interventional embolization is a safe, reliable and effective method to treat intracranial aneurysm, to obtain a good prognosis, the intervention time should be within3days after hemorrhage.
探讨血管内介入栓塞治疗颅内动脉瘤的疗效,总结临床经验并指导实践。
方法
采用MDS或GDC对108例颅内动脉瘤患者进行血管内介入栓塞治疗,观察近期、远期疗效,并进行疗效分析。
结果
完全栓塞98例(90.74%),不完全栓塞7例(6.48%),部分栓塞2例(1.85%),失败1例(0.93%)。发生并发症4例(3.70%)。术后3个月mRS评价,预后良好98例(90.74%),中度残疾5例(4.63%),重度残疾1例(0.93%),死亡4例(3.70%)。随访3-36个月,部分栓塞1例复发,再行GDC栓塞成功,其余未见复发,动脉瘤不复显影。血管内介入栓塞疗效随介入时机延迟和Hunt-Hess分级升高呈下降趋势,MDS与GDC栓塞无显著性差异。
结论
血管内介入栓塞是一种安全、可靠、有效的颅内动脉瘤治疗方法。
Objective
To investigate the efficacy of the intravascular interventional embolization on intracranial aneurysms, summarize the clinical experience and guide practice.
Methods
The MDS or GDC were used on108cases of patients with intravascular aneurysms to take intracranial interventional embolization, the recently, the long-term efficacy were observed, and analyzed the efficacy.
Results
98cases of complete embolization (90.74%),7cases of incomplete embolization (6.48%),2cases of partial embolization (1.85%), one cases was failure (0.93%). Complications occurred on4cases (3.70%). After3months took mRS evaluation,98cases had good prognosis (90.74%),5cases were moderate disability (4.63%),1cases was severe disability (0.93%),4patients died (3.70%). The patients were followed up for3to38months,1patients with partial embolization was recurrent, and with success by re-GDC embolization, the rest had no recurrence, the aneurysm was no longer developing. The efficacy of endovascular embolization showed a downward trend with intervention time delay and Hunt-Hess grade increases, the MDS and GDC embolization had no significant difference.
Conclusion
Endovascular interventional embolization is a safe, reliable and effective method to treat intracranial aneurysm, to obtain a good prognosis, the intervention time should be within3days after hemorrhage.
引文
[1]赵继宗,李美华.我国颅内动脉瘤基础研究现状与展望[J].中华医学杂志,2007,87(13)：865-867.
[2]余永铭,郭奕浩,覃成安.颅内动脉瘤的血管内介入栓塞治疗[J].广西医学,2009,31(12)：1803-1804.
[3]王志刚,丁旋,曲春城,等.手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效分析[J].中华神经外科杂志,2007,23(11)：840-841.
[4]刘磊,许百男.血流动力学和病理学因素在颅内动脉瘤发病机制中的作用[J].中华老年心脑血管病杂志,2008,10(5)：391-392.
[5]鲁峻,顾建军.43例颅内动脉瘤的显微手术治疗疗效观察[J].苏州大学学报(医学版),2008,28(5)：853-854.
[6]Karmonik C,Klucznik R,Benndof G.Comparison of velocity patterns in an AComA aneurysm measured with 2D phase contrast MRI and simulated with CFD[J].Technol Health Care,2008,16(2):119-128.
[7]成名,张锋玫,周军荣,等.水解可脱性弹簧圈栓塞治疗颅内动脉瘤31例报告[J].微创医学,2009,4(4)：379-380.
[8]冯广森、刘小玲、裴高猷,等.支架后解脱结合弹簧圈栓塞技术治疗颅内宽颈动脉瘤的临床应用[J].中国实用医刊,2012
[9]何建军,余肖春.早期介入栓塞治疗脑动脉瘤破裂30例[J].实用医学杂志,2011,27(3)：544-544.
[10]丁吴,游潮,邓琳,等.颅内动脉瘤破裂出血后不同时机手术效果及再出血风险[J].中风与神经疾病杂志,2008,25(3)：324-326.
[11]Kai Y,Hamada J,Morioka M,et al.Evaluation of the stability of small ruptured aneu rysms with a small neck after embolization with Guglielm idetachable coils:orrelation between coil packingratio and coil compaction[J].Neurosurgery,2005,56(4):785-792.
[12]郑琳,梁华新.560例颅内动脉瘤破裂手术时机选择临床观察分析[J].中国初级卫生保健,2010,24(6)：119-120.
[13]贺能树主编.中华影像医学介入放射学卷.北京：人民卫生出版社,2005.6.
[14]肖福顺,吴忠学.弹簧圈栓塞动脉瘤的组织病理学改变及再通的可能性[J].国外医学.神经病学神经外科分册,2000,27(4)：203-205.
[15]夏吉勇,贺军华,侯瑞光,等.水解微弹簧圈血管内栓塞治疗颅内动脉瘤的临床研究[J].北京医学,2008,30(2)：71-73.
[1]王伟治,神经病学(第四版)[M],北京：人民卫生出版社,2002,150.
[2]宋颖,何晓蕊,赵彩霞等,蛛网膜下腔出血病因分析及治疗选择[J],基层医学论坛,2007,11(6B)：511-512.
[3]兰心强, 郭世文.脑脊液置换术治疗蛛网膜下腔出血.临床研究[J].实用心脑肺血管病杂志,2011,19(6)：898-899.
[4]侯熙德.神经病学[M].3版.北京：人民卫生出版社,2000,126.
[5]DoraiZ, Linda SH, Thonas AK, et al. Factors related to hydroeephalus after aneurysmal subarachnoid hemorrhage[J]. Neurosurgery,2003,52(4):763-769.
[6]张彰国,殷鑫浈,张宝荣,81例原发性蛛网膜下腔出血临床及病因分析[J],浙江创伤外科,2005,10(5)：384～385.
[7]张聚斓,老年人与青壮年蛛网膜下腔出血临床特征比较[J],现代诊断与治疗,2010,21(3)：147～148.
[8]Vale FL, Bradley EL, Fisher WS. The relationship of subarachnoid hemorrhage and the need for postoperative shunting[J]. JNeurosurg,1997.68(3):462-466.
[9]Van Gijin J, Rinkel GJE. Subarachnoid hemorrhage:diagnosis, causes, and managemen[J]. Brain,2001,124(2):249-278.
[10]崔建仕,蛛网膜下腔出血50例病因分析[J],中国实用神经疾病杂志,2009,12(17)：53.
[11]陈星强,方学文,肖利华等,蛛网膜下腔出血病因、症状、影像和预后的临床分析[J],中国医师杂志,2006,增刊：90-91.
[12]郑桃林, 何伟, 王桂斌.Rho激酶与蛛网膜下腔出血后脑血管痉挛[J].卒中与神经疾病,2011,18(2)：125-127.
[13]Doran JD, Liu X, Taslimi P, et al. New insign into structurefunction and relationships of Rho-associated Kinase. A thermpdynamic and hydrodynamic and hydrodynamic study of the dimmer to monomer transition and its kinetic implications. Biochem J,2004, 384(2):255-262.
[14]Schievink WI. The clinical conundrum of convexal subarachnoid hemorrhage[J]. Neurology, 2005,3(3):146.
[15]Andrew J,Dutka MD, Pat rick M, et al. Influence of granulocyt openia on canine cerebral ischemia induced by air embolism [J]. Stroke,2009,20(3):390.
[16]Liu M, Wu B, Wang WZ, et al. Stroke in China:epidemiology, prevention, and management strategies [J]. Lancet Neurol,2007,6(5):456-464.
[17]Zhang LF, Yang J, Hong Z, etal. Proportion of diferent subtypes of stroke in China[J]. Stroke,2003,34(9):2091-2096.
[18]Syme PD, Byrne AW, Chen R, et al. Community-based stroke incideuce in a Scottish population:The Sco-ish Stroke Study. Stroke Study[J]. Stroke,2005,36:1837-184.
[19]Wolfe CD, Rudd AG, Howard, et al. Incidence and case fatality rate, and of stroke subtypes in a multiethnic population:the south London SPoke Register[J]. Neurol Neurosurg Psychiatry,2002,72:211-216.
[20]Tibor Becske著,吕正文,吴承远译,蛛网膜下腔出血.[M],国外医学脑血管疾病分册,2002,10(5)：330.
[21]Feign VL, Lawes CMM, BenneR DA, etal. Basic Stroke Epidemiology:An overview of population-based studies of incidence, prevalence and casefatality in the late 20th century[J]. Lancet NeurologY.2003,2:43-53.
[22]施国君, 刘俊雄, 王敏.一种新的兔蛛网膜下腔出血后症状性脑血管痉挛模型的建立[J].中国临床康复,2002,6(1)：134-135.
[23]冷冰,神经系统血管性疾病DSA诊断学(第1版)[M]。北京：人民卫生出版社,2010；16-17,177-178。
[24]黄庆梅,蛛网膜下腔出血295例临床分析[J],吉林大学硕十学位论文,2005：4.
[25]周俐红,张伟,MRA和DSA在蛛网膜下腔出血.的应用[J],临床医学,2010,2：200-201.
[26]Broderick JP, Viscoli CM, Brott J, et al, Major risk factors for aneurismal subaracnoid hemorrhage in the young are modifiable[J], Stroke,2003,34(6):1375~1378.
[27]黄春明,张宏祥,蛛网膜下腔出血规范化治疗[J],当代医学,2010,16(12)：52～53.
[28]赵丽宏,侯淼,宋仁兴.珠网膜下腔出血.后腰穿放液防治脑血管痉挛的临床观察[J].丹东医药,2004,(1)：20-21.
[29]宋锦宁,刘守勋等,动脉瘤性蛛网膜_下腔出血早期病因治疗与保守治疗效果的对照研究[J],中国急救医学,2007,27(1)：12-13.
[30]程树来,任安洲等,自发性蛛网膜下腔出血的病因诊断及介入治疗[J],中国神经医学杂志,2006,5(11)：1160-1161.
[31]赵欣春,白发性蛛网膜下腔出血1000例病因及CT估价方法[J],中风与神经疾病杂志,2003,20(3)：266-267.
[32]孙鹏、王伟等,手术时机对颅内动脉瘤性蛛网膜下腔出血患者预后的影响[J],宁夏医学杂志,2010,32(6)：518-519.
[33]陈旭.颅内静脉窦血栓形成继发珠网膜下腔出血临床分析[J].锦州医学院学报：2002,23(2)：28.
[34]刘子华.腰穿脑脊液置换鞘内注氧治疗外伤性蛛网膜下腔出血[J].中国民族民间医药,2009,18(7)：67.
[35]曹勇、孟阳等,腰穿置管脑脊髓引流与置换疗法对蛛网膜下腔出血的疗效对比[J],中国实用神经疾病杂志,2010,13(1)：58-59.
[36]屈阳,陈旭义等,RAUMDIC双腔脑室外引流管治疗蛛网膜下腔出血的应用研究[J],医疗卫生装备,2010,31(3)：78-79.
[37]谢伟坚.原发性蛛网膜下腔出血预后相关因素分析[J].中国医药指南,2011,09(16)：186-187.
[38]Labovitz DL, Halim AX, Brent B, et al. Subarachnoid Hemorhage incidence among White, Blacks and Carbbean Hispanics:the NorthernManhattan Study[J]. Neurpepidemiology,2006, 26(3):157-165.
[39]温淼、鞠奕等,蛛网膜下腔出血临床规范化路径对患者预后的影响[J],中国康复理论与实践,2010,16(4)：364-365.
[40]林施瑞,扬航,头部低温疗法在蛛网膜下腔出血中的应用[J],中国医药指南,2010,8(14)：70-71.
[41]赵法灵,陈勇等,中西医结合治疗创伤性蛛网膜下腔出血疗效观察[J],中国实用神经疾病杂志,2010,13(10)：57-58.
[42]陈博文,成杰, 田华,胡蝶,付爱军.蛛网膜下腔出血后脑血管痉挛的研究进展[J].华北煤炭医学院学报,2011,13(3)：319-321.
[43]彭华, 唐晓平, 张涛, 唐文国, 漆建, 罗仁国, 李舜, 段军伟.动脉瘤性蛛网膜下腔出血后脑积水的诊治[J].川北医学院学报,2011,26(3)：237-238.
[44]王涛, 赵永辰, 张玉仓, 刘双.中青年与老年蛛网膜下腔出血临床特点[J].医学研究与教育,2011,28(3)：27-29.
[45]]茹艳.蛛网膜下腔出血心电图改变分析[J].包头医学院学报,2011,27(1)：60-61.
[2]余永铭,郭奕浩,覃成安.颅内动脉瘤的血管内介入栓塞治疗[J].广西医学,2009,31(12)：1803-1804.
[3]王志刚,丁旋,曲春城,等.手术夹闭和血管内介入治疗颅内破裂动脉瘤的疗效分析[J].中华神经外科杂志,2007,23(11)：840-841.
[4]刘磊,许百男.血流动力学和病理学因素在颅内动脉瘤发病机制中的作用[J].中华老年心脑血管病杂志,2008,10(5)：391-392.
[5]鲁峻,顾建军.43例颅内动脉瘤的显微手术治疗疗效观察[J].苏州大学学报(医学版),2008,28(5)：853-854.
[6]Karmonik C,Klucznik R,Benndof G.Comparison of velocity patterns in an AComA aneurysm measured with 2D phase contrast MRI and simulated with CFD[J].Technol Health Care,2008,16(2):119-128.
[7]成名,张锋玫,周军荣,等.水解可脱性弹簧圈栓塞治疗颅内动脉瘤31例报告[J].微创医学,2009,4(4)：379-380.
[8]冯广森、刘小玲、裴高猷,等.支架后解脱结合弹簧圈栓塞技术治疗颅内宽颈动脉瘤的临床应用[J].中国实用医刊,2012
[9]何建军,余肖春.早期介入栓塞治疗脑动脉瘤破裂30例[J].实用医学杂志,2011,27(3)：544-544.
[10]丁吴,游潮,邓琳,等.颅内动脉瘤破裂出血后不同时机手术效果及再出血风险[J].中风与神经疾病杂志,2008,25(3)：324-326.
[11]Kai Y,Hamada J,Morioka M,et al.Evaluation of the stability of small ruptured aneu rysms with a small neck after embolization with Guglielm idetachable coils:orrelation between coil packingratio and coil compaction[J].Neurosurgery,2005,56(4):785-792.
[12]郑琳,梁华新.560例颅内动脉瘤破裂手术时机选择临床观察分析[J].中国初级卫生保健,2010,24(6)：119-120.
[13]贺能树主编.中华影像医学介入放射学卷.北京：人民卫生出版社,2005.6.
[14]肖福顺,吴忠学.弹簧圈栓塞动脉瘤的组织病理学改变及再通的可能性[J].国外医学.神经病学神经外科分册,2000,27(4)：203-205.
[15]夏吉勇,贺军华,侯瑞光,等.水解微弹簧圈血管内栓塞治疗颅内动脉瘤的临床研究[J].北京医学,2008,30(2)：71-73.
[1]王伟治,神经病学(第四版)[M],北京：人民卫生出版社,2002,150.
[2]宋颖,何晓蕊,赵彩霞等,蛛网膜下腔出血病因分析及治疗选择[J],基层医学论坛,2007,11(6B)：511-512.
[3]兰心强, 郭世文.脑脊液置换术治疗蛛网膜下腔出血.临床研究[J].实用心脑肺血管病杂志,2011,19(6)：898-899.
[4]侯熙德.神经病学[M].3版.北京：人民卫生出版社,2000,126.
[5]DoraiZ, Linda SH, Thonas AK, et al. Factors related to hydroeephalus after aneurysmal subarachnoid hemorrhage[J]. Neurosurgery,2003,52(4):763-769.
[6]张彰国,殷鑫浈,张宝荣,81例原发性蛛网膜下腔出血临床及病因分析[J],浙江创伤外科,2005,10(5)：384～385.
[7]张聚斓,老年人与青壮年蛛网膜下腔出血临床特征比较[J],现代诊断与治疗,2010,21(3)：147～148.
[8]Vale FL, Bradley EL, Fisher WS. The relationship of subarachnoid hemorrhage and the need for postoperative shunting[J]. JNeurosurg,1997.68(3):462-466.
[9]Van Gijin J, Rinkel GJE. Subarachnoid hemorrhage:diagnosis, causes, and managemen[J]. Brain,2001,124(2):249-278.
[10]崔建仕,蛛网膜下腔出血50例病因分析[J],中国实用神经疾病杂志,2009,12(17)：53.
[11]陈星强,方学文,肖利华等,蛛网膜下腔出血病因、症状、影像和预后的临床分析[J],中国医师杂志,2006,增刊：90-91.
[12]郑桃林, 何伟, 王桂斌.Rho激酶与蛛网膜下腔出血后脑血管痉挛[J].卒中与神经疾病,2011,18(2)：125-127.
[13]Doran JD, Liu X, Taslimi P, et al. New insign into structurefunction and relationships of Rho-associated Kinase. A thermpdynamic and hydrodynamic and hydrodynamic study of the dimmer to monomer transition and its kinetic implications. Biochem J,2004, 384(2):255-262.
[14]Schievink WI. The clinical conundrum of convexal subarachnoid hemorrhage[J]. Neurology, 2005,3(3):146.
[15]Andrew J,Dutka MD, Pat rick M, et al. Influence of granulocyt openia on canine cerebral ischemia induced by air embolism [J]. Stroke,2009,20(3):390.
[16]Liu M, Wu B, Wang WZ, et al. Stroke in China:epidemiology, prevention, and management strategies [J]. Lancet Neurol,2007,6(5):456-464.
[17]Zhang LF, Yang J, Hong Z, etal. Proportion of diferent subtypes of stroke in China[J]. Stroke,2003,34(9):2091-2096.
[18]Syme PD, Byrne AW, Chen R, et al. Community-based stroke incideuce in a Scottish population:The Sco-ish Stroke Study. Stroke Study[J]. Stroke,2005,36:1837-184.
[19]Wolfe CD, Rudd AG, Howard, et al. Incidence and case fatality rate, and of stroke subtypes in a multiethnic population:the south London SPoke Register[J]. Neurol Neurosurg Psychiatry,2002,72:211-216.
[20]Tibor Becske著,吕正文,吴承远译,蛛网膜下腔出血.[M],国外医学脑血管疾病分册,2002,10(5)：330.
[21]Feign VL, Lawes CMM, BenneR DA, etal. Basic Stroke Epidemiology:An overview of population-based studies of incidence, prevalence and casefatality in the late 20th century[J]. Lancet NeurologY.2003,2:43-53.
[22]施国君, 刘俊雄, 王敏.一种新的兔蛛网膜下腔出血后症状性脑血管痉挛模型的建立[J].中国临床康复,2002,6(1)：134-135.
[23]冷冰,神经系统血管性疾病DSA诊断学(第1版)[M]。北京：人民卫生出版社,2010；16-17,177-178。
[24]黄庆梅,蛛网膜下腔出血295例临床分析[J],吉林大学硕十学位论文,2005：4.
[25]周俐红,张伟,MRA和DSA在蛛网膜下腔出血.的应用[J],临床医学,2010,2：200-201.
[26]Broderick JP, Viscoli CM, Brott J, et al, Major risk factors for aneurismal subaracnoid hemorrhage in the young are modifiable[J], Stroke,2003,34(6):1375~1378.
[27]黄春明,张宏祥,蛛网膜下腔出血规范化治疗[J],当代医学,2010,16(12)：52～53.
[28]赵丽宏,侯淼,宋仁兴.珠网膜下腔出血.后腰穿放液防治脑血管痉挛的临床观察[J].丹东医药,2004,(1)：20-21.
[29]宋锦宁,刘守勋等,动脉瘤性蛛网膜_下腔出血早期病因治疗与保守治疗效果的对照研究[J],中国急救医学,2007,27(1)：12-13.
[30]程树来,任安洲等,自发性蛛网膜下腔出血的病因诊断及介入治疗[J],中国神经医学杂志,2006,5(11)：1160-1161.
[31]赵欣春,白发性蛛网膜下腔出血1000例病因及CT估价方法[J],中风与神经疾病杂志,2003,20(3)：266-267.
[32]孙鹏、王伟等,手术时机对颅内动脉瘤性蛛网膜下腔出血患者预后的影响[J],宁夏医学杂志,2010,32(6)：518-519.
[33]陈旭.颅内静脉窦血栓形成继发珠网膜下腔出血临床分析[J].锦州医学院学报：2002,23(2)：28.
[34]刘子华.腰穿脑脊液置换鞘内注氧治疗外伤性蛛网膜下腔出血[J].中国民族民间医药,2009,18(7)：67.
[35]曹勇、孟阳等,腰穿置管脑脊髓引流与置换疗法对蛛网膜下腔出血的疗效对比[J],中国实用神经疾病杂志,2010,13(1)：58-59.
[36]屈阳,陈旭义等,RAUMDIC双腔脑室外引流管治疗蛛网膜下腔出血的应用研究[J],医疗卫生装备,2010,31(3)：78-79.
[37]谢伟坚.原发性蛛网膜下腔出血预后相关因素分析[J].中国医药指南,2011,09(16)：186-187.
[38]Labovitz DL, Halim AX, Brent B, et al. Subarachnoid Hemorhage incidence among White, Blacks and Carbbean Hispanics:the NorthernManhattan Study[J]. Neurpepidemiology,2006, 26(3):157-165.
[39]温淼、鞠奕等,蛛网膜下腔出血临床规范化路径对患者预后的影响[J],中国康复理论与实践,2010,16(4)：364-365.
[40]林施瑞,扬航,头部低温疗法在蛛网膜下腔出血中的应用[J],中国医药指南,2010,8(14)：70-71.
[41]赵法灵,陈勇等,中西医结合治疗创伤性蛛网膜下腔出血疗效观察[J],中国实用神经疾病杂志,2010,13(10)：57-58.
[42]陈博文,成杰, 田华,胡蝶,付爱军.蛛网膜下腔出血后脑血管痉挛的研究进展[J].华北煤炭医学院学报,2011,13(3)：319-321.
[43]彭华, 唐晓平, 张涛, 唐文国, 漆建, 罗仁国, 李舜, 段军伟.动脉瘤性蛛网膜下腔出血后脑积水的诊治[J].川北医学院学报,2011,26(3)：237-238.
[44]王涛, 赵永辰, 张玉仓, 刘双.中青年与老年蛛网膜下腔出血临床特点[J].医学研究与教育,2011,28(3)：27-29.
[45]]茹艳.蛛网膜下腔出血心电图改变分析[J].包头医学院学报,2011,27(1)：60-61.