1537例颅内动脉瘤治疗临床分析

Clinical analysis in treatment of 1537 intracranial aneurysms

目的探讨颅内动脉瘤治疗方法的选择、手术和血管内治疗的适应证、安全性及影响预后的因素。方法回顾性分析2000年1月至2006年12月收治的1537例颅内动脉瘤患者，其中621例行血管内治疗、889例行显微外科手术治疗，27例行保守（未）治疗。结果血管内治疗组术后恢复良好589例，功能障碍22例，死亡10例；显微外科手术组恢复良好796例，功能障碍61例，死亡32例。结论应根据动脉瘤不同位置、形态、动脉瘤大小、临床分级、动脉瘤是否合并血栓、钙化、狭窄、是否累及穿支或分支血管、动脉瘤单发和多发及医生经验等多种因素综合考虑个体化选择治疗方法。

Objective To investigate the factors influencing decision-making in the treatment of intracranial aneurysms, indication of microsurgery and endovascular therapy, relevant factors to the prognosis. Method We retrospectively analyzed 1537 intracranial aneurysm patients, among whom 621 were treated with endovascular therapy, 889 were treated with microsurgery, 27 underwent conservative treatment. Mortality, morbidity, recurrence rate and rebleeding rate were concerned. Results In patients treated with endovascular therapy, 589 patients received good recovery（ Rankin scor 0 -2）,22 patients received poor recovery（ Rankin scor 3 -5）, 10 patients died. In patients treated with microsurgery, 796 patients received good recovery（ Rankin scor 0 - 2 ） ,61 patients received poor recovery（ Rankin scor 3 - 5 ） , 32 patients died. 11 patients died of rebleeding in conservative treatment group. Conclusions Decision- making depends on the location, size, morphology, quantity, Hunt-Hess grade and feature of parent artery, the experience of doctors and will of patients should also be considered.