颅内动脉瘤的显微手术和血管内栓塞治疗的疗效分析

Analysis on microsurgery and endovascular treatment for intracranial aneurysm

目的探讨颅内动脉瘤的显微手术和血管内介入治疗的方法选择、时机、术中术后的处理和疗效分析。方法回顾性分析215例(其中20例为多发动脉瘤)共246个颅内动脉瘤分别采用显微手术治疗(121例127个)和血管内栓塞治疗(104例119个),采用格拉斯哥结果量表(GOS评分)评价治疗效果,总结颅内动脉瘤治疗的经验和教训。结果显微手术组预后良好104例(86.0%),中残8例(6.6%),重残6例(5.0%),植物生存1例(0.8%),死亡2例(1.6%)。血管内栓塞组预后良好87例(83.7%),中残7例(6.7%),重残4例(3.8%),植物生存1例(1.0%),死亡5例(4.8%),术中因微导管插管困难致手术失败3例(2.9%)(改行显微手术后治愈)。结论显微手术和血管内介入治疗颅内动脉瘤均能取得满意的效果,两种方法各有利弊,相互补充,临床应根据动脉瘤的大小、部位、术者经验及患者意愿选择。

Objective To explore the option of the approaches and timing,the curative effect,intraoperative and postoperative treatment of microsurgery and endovascular intervention for intracranial aneurysm.Methods 246 intracranial aneurysms（including 20 cases of multiple intracranial aneurysms） in a total of 215 cases were analyzed retrospectively.One hundred and twenty-seven intracranial aneurysms in 121 cases underwent microsurgery,while 119 intracranial aneurysms in 104 cases underwent endovascular therapy.Results All patients evaluated by GOS（Glascow Outcome Scales）.Among the 121 cases with microsurgery,104 cases（86.0%） had good recovery,8 cases（6.6%） were moderate disability,6 cases（5.0%） were severe disability,1 case（0.8%） was in vegetative status,and 2 cases（1.6%） dead.Among those 104 cases with endovascular treatment,87 cases（83.7%） had good recovery,7 cases（6.7%） were moderate disability,4 cases（3.8%） were severe disability,1 case（1.0%） was in vegetative status,and 5 cases（4.8%） dead.Three cases（2.9%） were unsuccessful by this means,because of failure in the intubation of micro catheter,but cured with microsurgery treatment afterwards.Conclusions Both microsurgery and endovascular treatment for intracranial aneurysm are effective treatment.With their own merits and demerits,those two methods should be approached complementarily,Whether to choose microsurgery or endovascular treatment relies on not only the size and position of the aneurysm,but also the experience of the surgeon and the will of patients as well.