未破裂颅内动脉瘤不同处理方式与预后的关系

Relationship between treatment and prognosis of unruptured intracranial aneurysm

目的:研究未破裂颅内动脉瘤(unruptured intracranial aneurysms,UIAs)的不同处理方式与预后的关系。方法:对2006年6月到2009年12月收治的81例101枚UIAs患者进行回顾性分析,所有患者平均随访10.2月。其中夹闭组19例19枚动脉瘤,介入栓塞组11例12枚动脉瘤,观察组53例70枚动脉瘤。影像学随访58例70枚动脉瘤,其中夹闭组14枚,介入栓塞7枚,观察组49枚。结果:夹闭组均恢复日常生活,介入栓塞组2例轻度残疾,观察组死亡5例、中度残疾4例、轻度残疾1例。3组之间差异无统计学意义(P=0.125)。影像学随访发现UIAs多为中小型(<10 mm)。夹闭组均完全夹闭,介入栓塞1枚大部分栓塞,观察组1枚瘤颈增大、2枚瘤体增大、破裂5枚,其中破裂动脉瘤均为小动脉瘤(<5 mm)。3组之间差异无统计学意义(P=0.274)。结论:UIAs多为中小型,其破裂往往发生在小型动脉瘤。UIAs处理方式还需进一步明确。随着影像学的发展,未破裂颅内小动脉瘤检出率的不断提高,将给动脉瘤的处理带来新的挑战。

Objectives：To analyze the relationship between treatment and prognosis of unruptured intracranial aneurysms（UIAs）. Methods：Clinical data of 81 patients with 101 UIAs in the neurosurgery department of the First Affiliated of Chongqing Medical Uni- versity from June 2006 to December 2009（mean follow-up time of 10.2 months） were retrospectively analyzed. Patients were treated by 3 methods： （ 1 ） surgical clipping, 19 patients with 19 UIAs ; （2） coil embolization, 11 patients with 12 UIAs; （ 3 ） conservative obser- vation, 53 patients with 70 UIAs. Fifty-eight patients with 70 UIAs were followed radiologically including 14 UIAs in clipping group, 7 UIAs in coil embolized group and 49 UIAs in conservative observation group. Risk factors and relationship between treatment and prognosis of UIAs were analyzed. Results ： Patients in clipping group all resumed their daily lives; 2 patients in embolization group had slight disability;5 patients died,4 patients had moderate disability and 1 patient had mild disability in observation group;there was no significant difference among three groups （P=0.125）. Based on radiological follow-up, UIAs were mainly medium and small types （less than 10 mm）;14 UIAs in clipping group were clipped completely; 1 UIA in coil embolized group was partially embolized;in conser- vative observation group, 1 UIA had enlarged neck, 2 UIAs had enlarged body and 5 UIAs ruptured（the size of all ruptured UIAs was less than 5 mm）;there was no significant difference among three groups （P=0.274）. Conclusions：UIAs are mainly medium and small types and the size of ruptured UIAs is often less than 5 mm. Treatment of UIAs still needs clarification. With the development of radi- ologieal technology, more and more small UIAs are certain to be detected,which will bring a new challenge for neurologist in clinical settings.