外科手术和血管内治疗颅内动脉瘤的术后疗效分析

Surgical clipping versus endovascular embolization for treatment of intracranial aneurysms:an analysis of postoperative results

目的探讨外科手术和血管内栓塞治疗颅内动脉瘤患者的术后疗效。方法282例（337个）颅内动脉瘤患者，剔除55例采用联合手术（7例）或未经手术治疗（48例）的患者后，对其中的128例（45．4％）行血管内治疗，99例（35．1％）行外科手术治疗。回顾性分析两种治疗方法的术后并发症、住院时间和出院时的GOS评分。结果血管内治疗组和外科手术组预后良好率分别为91．4％和79．8％（x^2=6．380，P=0．012）；预后不良率分别为8．8％和20．2％（x^2=6．380，P=0．012）；两组的病死率分别为4．7％和5．1％（x^2=0．016，P=0．899），术后并发症发生率分别为36．36％和17．19％（x^2=10．791，P=0．001）。结论经过选择的颅内动脉瘤病例，血管内治疗优于外科手术治疗。

Objective To compare the postoperative results of endovascular embolization or surgical clipping in patients with intracranial aneurysms. Methods Two hundred and eighty-two patients with intracranial aneurysms treated with surgical clipping or endovascular embolization were reviewed between September 2003 and May 2005. The postoperative complications, length of hospitalization and Glasgow Outcome Scale （GOS） score at discharge in patients with the two interventions were compared. Of the 282 pa- tients with intracranial aneurysms, 7 （2. 5% ） were failed in their endovascular embolization and were treated with surgical clipping afterward. 128 （45.4%） were treated with endovascular embolization, 99 （35. 1% ） were treated with surgical clipping, and 48 received neither surgical clipping nor endovascular embelization for various reasons. Results The good outcomes （ GOS score 4, 5） in the groups of endovascular embolization and surgical clipping were 91.4% and 79. 8%, respectively; the poor outcomes （GOS score 1 to 3） were 8. 8% and 20. 2%, respectively; and their mortalities （ GOS score = 1 ） were 4. 7% and 5.1%, respectively. Conclusion For the selected patients with intracranial aneurysms, endovascular embolization may be superior to surgical clipping.