破裂性大脑中动脉瘤开颅夹闭与血管内栓塞的对比研究

Comparation of clipping or embolization on the treatment of patients with ruptured middle cerebral artery aneurysm

目的评价开颅夹闭与血管内栓塞治疗破裂性大脑中动脉瘤的早期疗效。方法对我科收治的破裂性大脑中动脉瘤患者,随机分为两组,A组(21例)予开颅夹闭术,B组(17例)予血管内栓塞术;比较两组的早期疗效。结果两组术前Hunt-Hess分级、年龄、性别无明显差异(P>0.05)。住院时间、术后脑梗死发生率、死亡率无明显差异(P>0.05);术后一月改良Rankin评分差异显著(P<0.05)。A组无死亡病例;B组1例血管内栓塞术中动脉瘤破裂死亡,1例术后大面积脑梗死死亡。结论破裂性大脑中动脉瘤开颅动脉瘤夹闭术后早期患者的症状改善状况优于血管内栓塞术,考虑原因为开颅夹闭术清除了动脉瘤周围的血肿,持续外引流蛛网膜下腔的积血及血性脑脊液。

Objective To evaluate the curative effect adopting neurosurgical clipping and endovascular embolization for the patients with ruptured middle cerebral artery aneurysm. Methods The clinical data of the patients with ruptured middle cerebral artery aneurysm operated by our department,including 21 cases （ group A） of neurosurgieal clipping＂ and 17 cases （ group B） of endovascular embolization. The curative effects were compared between two groups. Results There was no significant diference in the preoperative Hunt-Hess classification, age and gender between two groups （ P 〉 0.05 ）. There was no significant diferenee in the length of stay, the rates of postoperative cerebral infarction, mortality between two groups （P 〉0.05 ）, but postoperative modified Rankin Scale score were significantly higher in group A than those in group B （ P 〈 0.05 ）. No patient died in group A and two patients died in group B. Conclusions The method that adopt neurosurgical clipping has a significantly better curative effect of earlier period than endovascular embolization, maybe the neurosurgieal clipping can clear hematoma surrounding aneurysm and drainage bloody eerebrospinal fluid.