颅内动脉瘤的可脱式弹簧圈栓塞治疗(附178例临床分析)

EMBOLIZATION OF INTRACRANIAL ANEURYSM USING DETACHABLE COIL(178 CASES ANALYSIS)

目的 总结可脱式弹簧圈栓塞治疗颅内动脉瘤的临床经验。方法 1997年 1月～ 2 0 0 3年 2月对 178例动脉瘤采用可脱式弹簧圈栓塞治疗 ,其中 43例采用机械式可脱弹簧圈 (MDS)栓塞治疗 ,13 5例采用电解式可脱弹簧圈(GDC)栓塞治疗。结果 以 MDS栓塞组的 43例动脉瘤中 ,栓塞程度 10 0 %者 3 5例 (81% ) ;栓塞 90 %以上者 6例(14 % ) ;栓塞 90 %以下者 2例 (5% ) ,有 4例有弹簧圈短尾停留在载瘤动脉内 1～ 2 mm ,没出现临床症状。以 GDC栓塞组的 13 5例中 ,栓塞 10 0 % 12 6例 (93 % ) ;栓塞 90 %以上 8例 (6% ) ;栓塞 90 %以下 1例 (0 .7% )。全组手术死亡6例 (3 % ) ,术中出血 6例。 MDS组有 11例动脉瘤在栓塞后 3～ 3 2个月进行造影随访 ,其中 1例动脉瘤稍微变大 ,2例钨丝弹簧圈出现腐蚀溶解 ,动脉瘤复发 ,行再次栓塞。 GDC组有 15例栓塞后 6～ 17个月进行造影随访 ,均无变化。结论 MDS和 GDC都是颅内动脉瘤栓塞治疗的有效材料。GDC因其顺应性、可控性好 ,操作简单 ,安全可靠 ,效果好 ,是目前最主要的栓塞材料。

Objective\ To summarize the clinic exeperience of embolization of intracranial aneurysm by using detachable coil. Methods\ From January 1997 to February 2003, 178 patients were embolized using detachable coil, 43 cases were embolized by MDS,135 cases were embolized by GDC. Results\ In 43 cases embolized by MDS,total occlusion was achieved in 35 cases(81%); over 90% in 6 cases(14%), less than 90% in 2 cases(5%), 4 paitents had no clinical symptom although MDS escaped 1～2 mm. In 135 cases embolized by GDC, 126 were totally occluded, over 90% in 8 cases(6%), less than 90% in one case (0.7%). 6 patients died in the cohort(3%),6 cases bleeded in the surgery. 11 cases embolized by MDS were performed following-up cerebral angiography after 3～32 months, one case was experienced little enlargement of aneurysmal body, two recurring because tungsten spiral corroded, cured by second embolication. 15 cases embolized by GDC were performed following-up cerebral angiography after 6～17 months,had no change. Conclusions\ Both MDS and GDC are good materical in embolization of intracranial aneurysm. GDC is more preferable regarding its conformance, maneuverable, simple, safe, effective.