开颅夹闭和血管内栓塞治疗颅内动脉瘤的临床分析

Clinical analysis of microsurgical clipping and endovascular embolization on intracranial aneurysms

目的探讨不同方法治疗颅内动脉瘤影响预后的相关因素。方法93例颅内动脉瘤患者开颅手术治疗38例，观察手术时机、术中是否破裂、栽瘤动脉，临时阻断技术对其30d及6个月预后的影响；介入手术治疗67例，观察治疗方法、介入栓塞方法、介入栓塞程度等因素对其30d及6个月预后的影响。以预后为因变量，采用SPSS11．5统计软件进行资料处理，均采用x。检验分析。结果术中动脉瘤破裂对开颅手术患者30d及6个月预后的影响差异均有统计学意义（共42个动脉瘤，术中发生破裂16个，Pearson χ2值分别为5．203、10．886，P均〈0．05）。新材料的应用能改善介入手术的动脉瘤患者6个月的预后（共74个动脉瘤，应用旧材料23个，应用新材料51个，Pearson χ2值为5．544，RR2．364，95％CI1．197—4．669，P〈0．05），还能降低介入手术失败的比例，由43．5％（旧材料组）下降到18．0％（新材料组）（Pearson χ2值为5．542，P〈0．05）。结论对于开颅手术的颅内动脉瘤患者，术中破裂是30d及6个月以上预后重要的危险因素。对于介入治疗的患者，新材料的应用能改善患者6个月以上的预后，同时降低介入手术失败的比例。

Objective To explore prognostic relative factors of different therapy for patients with intraeranial aneurysm. Methods In 93 intracranial aneurysm patients,38 cases were managed through craniotomy, in whom the effects of operation time, intraoperative aneurysmal rupture （ IAR）, temporary arterial occlusion （ TAO ） on 30-day and 6-month prognosis were investigated ; while other 67 cases experienced endovascular treatment, in whom the similar parameters of the different therapy, types of endovascular treatment, and intracranial aneurysm embolization were evaluated. 30 days and 6 months prognosis were regarded as the dependent variable, and SPSS for Windows 11.5 was adopted for data processing. Chi-Square test was performed. Results IAR exerted significant difference to 30 days and 6 months prognosis in patients undergoing craniotomy and clipping, there were 42 intracranial aneurysm, of which 16 aneurysm ruptured （ χ2 = 5. 203,10.886, P 〈 0.05 ）. For patients undergoing endovascular treatment, the new ma- terial application could improve 6 months prognosis, in whom there were totaly 74 intracranial aneurysm, of which 23 aneurysm were managed by the use of old material for endovascular treatment and 51 aneurysm were managed by the use of new material for endovascular treatment（ χ2 = 5. 544 and RR = 2. 364,95 % CI 1. 197 - 4. 669, P 〈 0.05 ）. Unsuccessful ratio in the endovascular treatment was reduced simultaneously, from 43.5% （old material group） to 18.0% （new material group） （χ2 = 5. 542 ,P 〈0.05）. Conclusions IAR is the important risk factor,which affects 30 days or 6 months prognosis of patients with intracranial aneurysms managed through craniotomy and clipping. The new material application in the endovascular treatment improves 6 months prognosis, meanwhile unsuccessful ratio in the endovascular treatment is reduced simultaneously.