不同治疗方式和时机对颅内破裂动脉瘤患者短期疗效的影响

Effect of different management modalities and timings on the short-term efficacy in patients with ruptured intracranial aneurysms

目的观察显微外科手术和血管内治疗、不同时机（早期和延期，以72h为界限）治疗颅内破裂动脉瘤的短期临床疗效。方法回顾性分析299例（共328个动脉瘤）颅内破裂动脉瘤患者的临床资料，其中显微手术组186例，血管内治疗组113例。手术组中剔除15例患者后，29例为早期手术组，142例为延期手术组。血管内治疗组中37例为早期治疗组，76例为延期手术组。观察患者住院天数、出院和术后6个月格拉斯哥预后（GOS）评分及并发症情况。结果①手术组和血管内治疗组，病死率分别为5．9％（11／186）、3．5％（4／113），P〉0．05；治疗后6个月GOS评分良好率（4～5级）分别为84．5％（153／181）、95．5％（105／110），P〈0．01；平均住院天数分别为（16±7）、（12±6）d，P〈0．01。②手术组中，早期手术组和延期手术组病死率分别为10．4％（3／29）、3．5％（5／142），P〉0．05。住院天数为（14±5）、（17±7）d，P〈0，05；治疗后6个月GOS评分良好率分别为85．7％（24／28）、87．7％（121／138），P〉0．05。血管内治疗组中，早期治疗组和延期治疗组病死率分别为2．7％（1／37）、3．9％（3／76）；住院天数为（12±5）、（12±6）d；6个月GOS评分良好率为97．3％（36／37）、94．5％（69／73）。P均〉0．05。③术后手术组的脑血管痉挛发生率高于血管内治疗组（25．8％，9．7％，P〈0．01）；再出血、脑积水发生率等并发症，两组比较差异无统计学意义。结论采用血管内治疗颅内破裂动脉瘤短期临床疗效优于显微手术。不同治疗时机对患者预后无显著影响。

Objective To observed the clinical efficacy of management of ruptured intracranial aneurysms with different modalities （microsurgery or endovascular treatment） and timings of treatment（ within or delayed after 72 hours）. Methods The clinical data of 299 patients with 328 aneurysms were analyzed retrospectively. They were divided into microsurgery group （n = 186 ） and endovascular treatment group （n = 113 ）. After 15 patients were excluded from the microsurgery group, there were 29 in the early operation group and 142 in the delayed operation group. In the endovascular treatment group, there were 37 in the early operation group and 76 in the delayed operation group. The hospitalization days, the Glasgow Outcome Scale （GOS） scores and the complications at discharge and 6 months after the procedure were observed. Results @The mortality rates in the microsurgery group and the endovascular treatment group were 5. 9% （11/186） and 3. 5% （4/113. P 〉 0. 05 ）, respectively; the favorable rates of GOS scores （Grade Ⅳ to Ⅴ ） at 6 months after the treatment were 84.5% （ 153/181 ） and 95.5% （ 105/110. P 〈 0. 01 ）, respectively; the average hospitalization days were 16 ± 7 and 12 ± 6 days （P 〈 0.01 ）, respectively. （2）The mortality rates in the early and the delayed operation group were 10.4% （3/29） and 3.5% （5/142.P 〉0.05 ）, respectively; the average hospitalization days were 14 ± 5 and 17 ± 7 days （ P 〈 0.05 ）, respectively; the favorable rates of GOS score at 6 months after the treatment were 85.7% （24/28） and 87.7% （121/138. P 〉 0.05）, respectively; in the endovascular treatment group, the mortalities in the early operation and delayed operation groups were 2.7% （1/37） and 3.9% （3/76）, respectively; the average hospitalization days were 12 ± 5 and 12 ± 6 days, respectively; the favorable rates of GOS scores at 6 months were 97.3% （36/37） and 94.5% （69/73. P 〉 0.05 all）, respectively. The incidence of cerebral vasospasm in the microsurgery group was significantly higher than that in the endovascular treatment group （25.8% vs 9. 7% , P 〈 0.01 ） ; there were no significant difference between the 2 groups in the complications such as of re-bleeding and hydrocephalus. Conclusion The short-term clinical efficacy of endovascular treatment in patients with ruptured intracranial aneurysms is superior to microsurgery, while the different timings of treatment opportunities has no affect on the prognosis of patients significantly.