破裂颅内动脉瘤的早期显微手术与介入治疗的比较研究

Comparative Study on Curative Effects of Initial Microsurgery and Endovascular Embolization Treatment for Broken Intracranial Aneurysm

目的分析颅内破裂动脉瘤显微手术与血管内栓塞治疗的临床疗效,探讨对不同形式的颅内动脉瘤及不同病情的病人的治疗适应征.方法144例颅内动脉瘤病人,分为显微手术组72例,介入治疗组72例.根据病人入院时的Hunt-Hess病情分级结合出院时病人的GOS评分分析其治疗结果.结果72例显微手术者中院内死亡2例;6个月后GOS评分:5分(恢复良好)51例,4分(轻度残疾)10例,3分(严重残疾)6例,2分(植物生存)3例,1分(死亡)0例.72例血管内栓塞治疗者中院内死亡2例;随访6个月,G0S评分:5分58例,4分4例,3分4例,2分4例,1分0例.两组治疗效果差异无统计学意义(P>0.05).结论显微手术与血管内栓塞治疗动脉瘤这两种治疗方法疗效无明显差异,部分患者联合应用两种方法效果更好.远期疗效还需要长期随访.

Objective To discuss the indications of different kinds of intracranial aneurysmc and patients through two kinds of therapeutic methods, microsurgery and endovascular embolization in the treatment of intracranial aneurysms by comparing their clinical therapeutic effects. Methods All the 144 patients were assigned to either microsurgery or endovascular treatment group. We analyzed the therapeutic effects according to the Hunt-Hess standard of admitpatients＇and GOS grade of discharge-patients. Results 72 patients received microsurgery, 2 patients died in hospital; according to the GOS grade 6 months after operation： 5 scores （satisfactory recovery） were obtained in 51 patients, 4 scores （mild disability） in 10.3 scores （severe disability） in 6, 2 scores （plant exist） in 3 and 1 score （death） in 0.72 patients received endovascular embolization, 2 patients died in hospital, according to the GOS grade 6 months after treatment, 5 scores were obtained in 58 patients, 4 scores in 4, 3 scores in 4, 2 scores in 4 and 1 score in 0. There was no statistic＂ difference in therapeutic effects between the two groups （P 〉 0.05）. Conclusions There is no significant difference in therapeutic effect between the two methods, microsurgery and endovascular embolization in the treatment of intracranial aneurysms, to some patients, combination of the two methods can be better. Long-term effects need long term follow-tip.