床突旁动脉瘤血管内介入治疗的疗效及影响因素分析

Factors affecting of curative effect of endovascular treatment for paraclinoid aneurysms

目的 探讨床突旁动脉瘤血管内治疗长期效果的影响因素,评价其治疗的安全性及疗效.方法 回顾性收集长海医院神经外科2010年1月至2011年12月采用血管内介入治疗,并有6个月以上DSA随访资料的129例床突旁动脉瘤患者的临床及影像学资料,按照随访结果分为复发组与未复发组,分析患者临床状况、治疗策略与材料选择、动脉瘤形态学对介入治疗长期预后的影响.结果 单因素分析显示,高血压、瘤体最大径大小、体颈比和即刻栓塞结果在复发组（n=19）和未复发组（n =110）两组间分布差异均有统计学意义（P＜0.05）.多因素分析结果表明：影响床突旁动脉瘤血管内介入治疗后复发的因素有高血压（P =0.0094）、破裂动脉瘤（P=0.0108）和瘤体最大径（P =0.0197）.结论 床突旁动脉瘤血管内治疗后具有一定的复发率,高血压病史、破裂动脉瘤及瘤体最大径较大与复发相关.

Objective To evaluate safety and efficacy of endovascular treatment for paraclinoid aneurysms and explore the factors influencing the long-term outcome.Methods The medical records and radiologic images of 129 patients with paraclinoid aneurysms during 2010 Jan to 2011 Dec treated by endovascular embolization in Changhai hospital were reviewed retrospectively.We analyzed the factors affecting the long-term outcomes of endovascular treatment,including clinical status,treatment strategy,selection of the equipment and aneurysmal morphology.Results In univariate analysis,hypertension,ruptured aneurysms,maximum diameter,dome-to-neck ratio and immediate result showed significant difference between the 2 groups （P ＜ 0.05）.Multivariate logistic regression analysis found hypertension （P =0.0094）,ruptured aneurysms （P =0.0108） and larger maximum diameter （P =0.0197） are predictors of recanalization.Conclusions Endovascular treatment of paraclinoid aneurysm has a risk of recurrence.Hypertension,ruptured aneurysms and larger maximum diameter are independent risk factors of recurrence.