弹簧圈栓塞与显微外科夹闭治疗颅内动脉瘤的临床疗效比较

Clinic Effect of Spring Coil Embolism versus Microsurgery Clipping for the Treatment of In- tracranial Aneurysm

[目的]探讨比较颅内动脉瘤弹簧圈栓塞与显微外科夹闭治疗的临床疗效.[方法]对经16层螺旋CTA（MSCTA）和数字减影血管造影（DSA）证实颅内动脉瘤患者89例,54例行DSA下弹簧圈栓塞治疗,35例行显微外科夹闭治疗,术后用日常生活活动量表（ADL）中Barthel指数（BI）来评价两者的疗效.[结果]89例中,弹簧圈栓塞54例,外科手术夹闭35例.前循环动脉瘤59例,弹簧圈栓塞35例,外科手术夹闭24例,两者疗效对比无显著差异（P＞0.05）;后循环动脉瘤30例,弹簧圈栓塞17例,外科手术夹闭11例,两者疗效对比有差异（P＜0.05）.53例动脉瘤直径＜10 mm,弹簧圈栓塞32例,外科手术夹闭21例,两者疗效对比无显著差异（P＞0.05）;36例直径≥10 mm,弹簧圈栓塞22例,外科手术14例,疗效比较有差异（P＜0.05）.两组疗效从动脉瘤生长的位置、大小及病人的临床状态对比来看,弹簧圈栓塞疗效优于显微外科治疗.[结论]弹簧圈栓塞和显微外科夹闭是治疗颅内动脉瘤的主要方法,从总体疗效对比分析结果来看,可优先选择血管内栓塞治疗,但临床仍应根据具体情况综合分析、权衡利弊、正确的选择治疗方法.

[Objective] To compare and analyze the effects of spring coil embolism versus microsurgery clipping for the treatment of intracranial aneurysm. [Methods] Eighty nine patients were diagnosed as intracranial aneurysm confirmed by 16-slice spiral CTA（MSCTA） or digital subtraction angiography（DSA）. Fifty four aneurysms were treated by spring coil embolism and 35 aneurysms were treated by microsurgery clippings. Both therapeutic effects were compared and analyzed by Barthel Index （BI） of activities of daily living scale（ADL）. [Results] Of 89 aneurysms, 54 cases were treated by spring coil embolism and 35 cases were treated by microsurgery clipping. Of 59 ante-circulation aneurysms, 35 cases were treated by spring coil em- bolism and 24 cases were treated by microsurgery clipping, and there was no significant difference in therapeutic effect between two groups （ P 〉0. 05）. Of 30 post-circulation aneurysms, 17 cases were treated by spring coil embolism and 11 cases were treated by microsurgery clipping, and there was significant difference in therapeutic effect between two groups （ P 〈0.05）. Of 53 aneurysms of diameter less than 10mm, 32 cases were treated by spring coil embolism and 21 cases were treated by microsurgery clipping, and there was no significant difference in therapeutic effect between two groups （ P 〉0.05）. Of 36 aneurysms of diameter more than 10mm, 22 cases were treated by spring coil embolism and 14 cases were treated by microsurgery clipping, and there was significant difference in therapeutic effect between two groups （ P 〈0. 05）. Through comparing the location and size of aneurysms and the clinic condition of patients, the therapeutic effect of spring coil embolism was better than that of microsurgery. [Conclusion]Spring coil embolism and microsurgery clipping are the major methods for treating intracranial aneurysm. Spring coil embolism is preferred for its total therapeutic effect. Therapeutic means should be selected according to clinical manifestation and individual situation.