急诊夹闭与栓塞治疗颅内破裂动脉瘤的疗效初析

Endovascular or Surgical Treatment of Acutely Ruptured Cerebral Aneurysms

目的:比较急诊动脉瘤夹闭术和血管内介入栓塞术治疗颅内破裂动脉瘤的疗效.方法:对62例颅内破裂动脉瘤急诊治疗,其中开颅夹闭组39例、栓塞组23例.术后随访3～28个月,夹闭组31例、栓塞组22例(失随访9例).结果:夹闭组治愈30例 ,栓塞组治愈20例 ( P＜0.01).术中动脉瘤破裂:夹闭组5例;围手术期死亡:夹闭组3例;下视丘反应:夹闭组8例、栓塞组3例;认知和肢体功能障碍:夹闭组2例、栓塞组1例;植物状态:夹闭组1例.随访:夹闭组1例死亡.结论:急诊血管内栓塞术操作安全、疗效优于开颅夹闭术,特别是对Hunt-Hess(H&H)分级为Ⅳ～Ⅴ级的患者可增加生存和治愈机会,但不能完全替代夹闭术,两者的远期效果需进一步观察.

Aim： This prospective study was conducted to compare the outcomes of significant benefit with the use of endovascular coils and vascular clips for the treatment in acute subarachnoid hemorrhage （SAH）.Methods： Sixty-two consecutive patients were randomly assigned to either surgical （ n = 39） or endovascular （ n = 23） treatment groups. Clinical and neuropsychological outcome was assessed at 3 and 28 months after treatment. Follow-up angiography was taken in clipping （n = 31） and endovascular （n = 22）. Results：Of 39 patients with surgical operation, 5 had ruptured intracranial aneurysm, 3 perioperation death, 8 hypothalamus reaction. Only 3 cases with endovascular treatment had hypothalamus reaction. In addition, cure occurred in 30/39 with surgical operation and 20/23 with endovascular treatment, 1 death in surgical operation group during the periods of follow-up （ P 〈 0.01 ）. Conclusion： Clinical outcomes seem comparable after early surgical and endovascular treatment of acute ruptured intracranial aneurysms. The long-term efficacy of endovascular treatment remains.