颅内栓塞术后复发动脉瘤不同干预方式疗效分析

Analysis of secondary intervention methods for recurrence intracranial aneurysm after intracranial embolization

目的 对比不同的二次干预方式对栓塞术后复发动脉瘤的疗效.方法 采用回顾性队列研究方法.纳入2010年1月—2016年12月北京市大兴区人民医院神经外科栓塞术后动脉瘤复发患者共101 例,其中男36例,女65例;首次发病年龄15~69(45 ± 11)岁,复发年龄16~76(48 ± 11)岁.根据二次干预方式不同分为手术组(24例)、栓塞组(39例)、栓塞+支架组(30例)、保守组(8例),分析患者治疗前后改良Rankin量表(mRS)评分变化、干预后是否存在并发症、干预后是否再复发,判断不同干预方式的治疗效果.结果 4组复发动脉瘤患者的二次干预时年龄、合并高血压或糖尿病、吸烟、动脉瘤破裂发生率、动脉瘤直径及瘤颈宽度、mRS评分变化及并发症发生率比较差异均无统计学意义(P值均>0.05);各组间动脉瘤部位存在统计学差异(χ2 =37.485, P<0.05);二次干预前后mRS比较各组间差异无统计学意义;二次干预后手术组复发0 例(0% )、栓塞组10 例(25.6% ,10/39)、栓塞+支架组3例(10% ,3/30)、保守组2例复发进展(2/8),4组间动脉瘤再复发率比较差异有统计学意义(χ2 =8.986, P<0.05).结论 对于复发动脉瘤,开颅夹闭、介入栓塞及支架辅助等均为有效的治疗方式,其中,开颅夹闭较介入治疗具有更低的再复发率;对于保守治疗的复发动脉瘤患者,需要严密随访观察.

Objective To compare the effects of different managements on recurrent aneurysms after embolization.Methods The retrospective cohort study was conducted.Clinical data of 101 patients who admitted at our institution from January 2010 to December 2016 were collected.There were 36 males and 65 females.The age of first onset was 15-69(45±11)years,the age of recurrence was 16-76(48±11)years.All of those patients were confirmed with intracranial recurrent aneurysms.According to the secondary intervention,the patients were divided into the operation group(24 cases),the embolization group(39 cases),the embolization+stent group(30 cases),and the conservative group(8 cases).The patients were analyzed for changes in the modified RANKIN scale(mRS)score before and after treatment,whether there were complications after intervention,and whether they relapsed after intervention,and the effects of different intervention methods were judged.Results There were no significant differences in age,hypertension or diabetes,smoking,aneurysm rupture,aneurysm diameter and neck width,mRS score,and complication rate in the second group of patients with recurrent aneurysms(all P values>0.05).There were statistical differences in the aneurysms between the groups(χ2=37.485,P<0.05).There was no significant difference in mRS between the two groups before and after the second intervention.After the second intervention,0 case recurred in the operation group,10 cases(25.6%,10/39)in the embolization group,3 cases(10%,3/30)in the embolization+stent group,and 2 cases in the conservative group(2/8).There was a statistically significant difference in the recurrence rate of tumors(χ2=8.986,P<0.05).Conclusions Surgical clipping,endovascular embolization and coiling with stent are effective treatment methods for recurrent aneurysms.Among them,aneurysms with surgical clipping has a lower recurrence rate than interventional therapy.Close follow-up observation is needed for conservative patients with recurrent aneurysms.