开颅夹闭术与血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤破裂效果的比较研究

Comparison of Clinical Effect in Treating Young and Middle-aged Patients with High-risk Ruptured Intracranial Aneurism between Craniotomy Clipping and Endovascular Intervention Aneurysm Embolization

目的比较开颅夹闭术与血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤破裂的效果。方法选择2011年4月—2014年3月在承德医学院附属医院神经外科接受治疗的中青年高危颅内动脉瘤破裂患者94例,根据手术指征和患者情况分为A组53例和B组41例。A组患者采用开颅夹闭术治疗,B组患者采用血管内介入动脉瘤栓塞术治疗。比较两组患者手术前后Hunt-Hess分级、术后3个月Rankin量表评分、术后并发症情况及住院情况(包括住院时间、医疗费用)。结果两组患者手术前后Hunt-Hess分级、术后3个月Rankin量表评分及术后并发症发生率比较,差异无统计学意义(P>0.05);A组患者住院时间长于B组,医疗费用低于B组(P<0.05)。结论开颅夹闭术和血管内介入动脉瘤栓塞术治疗中青年高危颅内动脉瘤均有良好的治疗效果,开颅夹闭术是多发性动脉瘤、颅内血肿形成、载瘤动脉解剖位置较复杂、瘤体较大患者的首选方案;而血管内介入动脉瘤栓塞术更适用于年龄较大、手术耐受力差、瘤体位置较深患者。

Objective To compare the clinical effect in treating young and middle-aged patients with high-risk ruptured intracranial aneurism between craniotomy clipping and endovascular intervention aneurysm embolization. Methods From April 2011 to March 2014,a total of 94 young and middle-aged patients with high-risk ruptured intracranial aneurism were selected in the Department of Neurosurgery,the Affiliated Hospital of Chengde Medical College,and they were divided into A group（ n = 53） and B group（ n = 41） according to surgical indication and individual situation. Patients of A group were treated by craniotomy clipping,while patients of B group were treated by endovascular intervention aneurysm embolization. Hunt-Hess grade before and after surgery,Rankin scale score after 3 months of surgery,incidence of postoperative complications,hospital stays and medical expenses were compared between the two groups. Results No statistically significant differences of Hunt-Hess grade was found between the two groups before or after surgery,nor was Rankin scale score after 3 months of surgery or incidence of postoperative complications between the two groups（ P〈0. 05）; hospital stays of A group was statistically significantly longer than that of B group,while medical expenses of A group was statistically significantly less than that of B group（ P〈0. 05）. Conclusion Both of craniotomy clipping and endovascular intervention aneurysm embolization have certain clinical effect in treating young and middle-aged patients with high-risk ruptured intracranial aneurism; craniotomy clipping is the first choice of patients with multiple aneurysms,intracranial hematoma formation,complex anatomical position of parent artery and relatively large aneurysm,while endovascular intervention aneurysm embolization is applicative in the patients with advanced age,poor surgery tolerance and deep-location aneurysm.